Effects of preeclampsia and eclampsia on maternal metabolic and biochemical outcomes in later life: a systematic review and meta-analysis

Abstract

Objective: To evaluate the association between preeclampsia (PE) and eclampsia (E) on subsequent metabolic and biochemical outcomes. Methods: Systematic review and meta-analysis of observational studies. We searched five engines until November 2018 for studies evaluating the effects of PE/E on metabolic and biochemical outcomes after delivery. PE was defined as presence of hypertension and proteinuria at N20 weeks of pregnancy; controls did not have PE/E. Primary outcomes were blood pressure (BP), body mass index (BMI), metabolic syndrome (MetS), blood lipids and glucose levels. Random effects models were used for meta-analyses, and effects reported as risk difference (RD) or mean difference (MD) and their 95% confidence interval (CI). Subgroup analyses by time of follow up, publication year, and confounder adjustment were performed. Results: We evaluated 41 cohorts including 3300 PE/E and 13,967 normotensive controls. Women were followed up from 3 months after delivery up to 32 years postpartum. In comparison to controls, PE/E significantly increased systolic BP (MD = 8.3 mmHg, 95%CI 6.8 to 9.7), diastolic BP (MD = 6.8 mmHg, 95%CI 5.6 to 8.0), BMI (MD = 2.0 kg/m 2 ; 95%CI 1.6 to 2.4), waist (MD = 4.3 cm, 95%CI 3.1 to 5.5), waist-to-hip ratio (MD = 0.02, 95%CI 0.01 to 0.03), weight (MD = 5.1 kg, 95%CI 2.2 to 7.9), total cholesterol (MD = 4.6 mg/dL, CI 1.5 to 7.7), LDL (MD = 4.6 mg/dL; 95%CI 0.2 to 8.9), triglycerides (MD = 7.7 mg/dL, 95%CI 3.6 to 11.7), glucose (MD = 2.6 mg/dL, 95% CI 1.2 to 4.0), insulin (MD = 19.1 pmol/L, 95%CI 11.9 to 26.2), HOMA-IR index (MD = 0.7, 95%CI 0.2 to 1.2), C reactive protein (MD = 0.05 mg/dL, 95%CI 0.01 to 0.09), and the risks of hypertension (RD = 0.24, 95%CI 0.15 to 0.33) and MetS (RD = 0.11, 95%CI 0.08 to 0.15). Also, PE/E reduced HDL levels (MD = -2.15 mg/dL, 95%CI -3.46 to −0.85). Heterogeneity of effects was high for most outcomes. Risk of bias was moderate across studies. Subgroup analyses showed similar effects as main analyses. Conclusion: Women who had PE/E have worse metabolic and biochemical profile than those without PE/E in an intermediate to long term follow up period.

Maternal obesity and metabolic disorders associate with congenital heart defects in the offspring: A systematic review

“…The incidence of MetS often parallels the incidence of obesity, which has nearly tripled worldwide since 1975 [ 87 ], and Centers for Disease Control and Prevention estimated that 40% of women aged 20–39 years old in the United States had a BMI ≥ 30 kg/m 2 in 2017–2018 [ 88 ]. Maternal obesity and dyslipidaemia increases the risk of developing both PE and GDM [ 89 , 90 ], GDM closely associated with risk of DM2, PE increases the risk of future chronic hypertension [ 91 ], and studies indicate that women with PE have increased risk of insulin resistance later in life [ 92 ]. So, the maternal metabolic disorders might be related to later MetS (except for DM1), and all components are associated with CHDs in offspring–either individually or with an additive effect.…”

Maternal obesity and metabolic disorders associate with congenital heart defects in the offspring: a systematic review

“…The incidence of MetS often parallels the incidence of obesity, which has nearly tripled worldwide since 1975 [86], and Centers for Disease Control and Prevention estimated that 40% of women aged 20-39 years old in the United States had a BMI ≥ 30 kg/m 2 in 2017-2018 [87]. Maternal obesity and dyslipidaemia increases the risk of developing both PE and GDM [88,89], GDM closely associated with risk of DM2, PE increases the risk of future chronic hypertension [90], and studies indicate that women with PE have increased risk of insulin resistance later in life [91]. So, the maternal metabolic disorders might be related to later MetS (except for DM1), and all components are associated with CHDs in offspring – either individually or with an additive effect.…”

Preeclampsia negatively affects future maternal metabolic and endocrine outcomes

“…Overweight and obese women who had preeclampsia during their pregnancy present at the first postpartum year a higher risk of displaying sustained hypertension and hypertension with abnormal biomarkers as compared to women with normotensive pregnancies [13]. Our meta-analysis [10] showed that pregnancies complicated with preeclampsia displayed, many years later, significantly increased weight, BMI, waist circumference, and waist-to-hip ratio; in addition to higher levels of total cholesterol, LDL-C, triglycerides, glucose, insulin, HOMA-IR, C reactive protein, and a higher risk of developing hypertension and the metabolic syndrome in comparison to healthy pregnancies. These results show that women with a history of preeclampsia have a worse endocrine and metabolic profile in the future, and a higher chance of developing cardiovascular disease.…”

“…Preeclampsia has not only important clinical implications on maternal and fetal outcomes but also on future maternal cardiovascular disease and endocrine/metabolic outcomes even years after a given pregnancy [8][9][10]. Over the past decades, cohort studies and meta-analyses have elucidated a significantly higher risk of cardiac, cerebrovascular, and peripheral arterial disease in women with a history of preeclampsia compared to those with uncomplicated pregnancies [9,11,12].…”