Hypertensive Disorders of Pregnancy and Risk of Cardiovascular Disease-Related Morbidity and Mortality: A Systematic Review and Meta-Analysis

Abstract

Introduction: Several studies have demonstrated that there is a higher risk of cardiovascular disease (CVD) in women with a history of hypertensive disorders of pregnancy (HDP). However, effect sizes varied greatly between these studies, and a complete overview of the existing data in the literature is lacking. We aimed to evaluate the association between HDP and the risk of CVD-related morbidity and mortality. Methods: Systematic literature searches were conducted in several electronic databases from inception to July 2019. Exposure of interest was any type of HDP. Outcomes of interest included any CVD, CVD-related mortality, and hypertension. Results: Sixty-six cohort and 7 case-control studies involving > 13 million women were included. The overall combined relative risks (RRs) for women with a history of HDP compared with the reference group were 1.80 (95% confidence interval [CI] 1.67-1.94) for any CVD, 1.66 (1.49-1.84) for coronary artery heart disease, 2.87 (2.14-3.85) for heart failure, 1.60 (1.29-2.00) for peripheral vascular disease, 1.72 (1.50-1.97) for stroke, 1.78 (1.58-2.00) for CVD-related mortality, and 3.16 (2.74-3.64) for hypertension. Significant heterogeneity was partially explained by all or part of the variables including type of exposure, follow-up time, geographic region, and sample source. Conclusions: Women with a history of HDP are at an increased risk of future CVD-related morbidity and mortality. Our study highlights the importance of lifelong monitoring of cardiovascular risk factors in women with a history of HDP.

Menopause and cardiometabolic diseases: What we (don't) know and why it matters

“…[51] In addition, high estrogenic exposure in premenopausal women, such as in case of pregnancy, was associated with adverse metabolic changes (hyperglycemia or increased blood pressure) which could impact the risk of developing T2D and hypertension later in life. [52,53] In line with this, in postmenopausal women, higher serum estradiol levels may be linked with pro-atherogenic lipid profile, blood pressure increase, impaired blood glucose, increased risk of T2D and stroke. [18,[54][55][56][57][58] The Three-City prospective study reported high levels of endogenous estradiol were predictor of the risk of CHD and stroke among postmenopausal women older than 65 years, while data from Rotterdam Study showed that among postmenopausal women with carotid atherosclerosis, high levels of circulating estradiol were associated with both increased likelihood of having unstable carotid plaque and increased risk of stroke.…”

Defective Uteroplacental Vascular Remodeling in Preeclampsia: Key Molecular Factors Leading to Long Term Cardiovascular Disease

“…In terms of timing, it has been known that within one or two decades after delivery, women with a history of HDP are more likely to experience premature cardiovascular events, such as symptomatic heart failure, myocardial ischemia, and cerebral vascular disease [ 112 , 113 ]. Two systematic reviews and meta-analyses demonstrated that the increased risk for CVD and hypertension is greater during the first 10 years after a pregnancy affected by HDP compared to the risk past 10 years after the affected pregnancy [ 97 , 114 ]. Up to one third of women with a history of HDP may develop hypertension within a decade of the affected pregnancy before middle age, indicating that they are more likely to develop CVD at a much younger age compared to controls [ 115 ].…”

Maternal Hypertensive Pregnancy Disorders and Mental and Behavioral Disorders in the Offspring: a Review

“…Hypertensive pregnancy disorders, including chronic hypertension, gestational hypertension, preeclampsia, and eclampsia complicate up to 5-8% of all pregnancies [1]. Metaanalytic evidence shows that hypertensive pregnancy disorders predict an increased risk of cardiovascular disease and premature mortality in the mother [2][3][4] and of preterm birth [5,6], small for gestational age (SGA) birth [5], stillbirth and neonatal death [5], and higher systolic and diastolic blood pressure and body mass index (BMI) [7] in the offspring.…”