Recurrence of pre‐eclampsia and the risk of future hypertension and cardiovascular disease: a systematic review and meta‐analysis

Abstract

BackgroundWomen with a history of hypertensive disorders, including pre‐eclampsia, during pregnancy have a two‐ to‐five‐fold increased risk of cardiovascular disease (CVD). In 15% of women, pre‐eclampsia recurs in the following pregnancy.ObjectivesTo evaluate all evidence on the future risk of developing hypertension and CVD after multiple pregnancies complicated by pre‐eclampsia compared with pre‐eclampsia in a single pregnancy followed by normal subsequent pregnancy.Search strategyEmbase and Medline were searched until June 2017.Selection criteriaAll relevant studies on the risk of developing hypertension, atherosclerosis, ischaemic heart disease, cerebrovascular accident (CVA), thromboembolism, heart failure or overall hospitalisation and mortality due to CVD after having had recurrent pre‐eclampsia.Data collection and analysisTwenty‐two studies were included in the review. When possible, we calculated pooled risk ratios (RR) with 95% CI through random‐effect analysis.Main resultsRecurrent pre‐eclampsia was consistently associated with an increased pooled risk ratio of hypertension (RR 2.3; 95% CI 1.9–2.9), ischaemic heart disease (RR 2.4; 95% CI 2.2–2.7), heart failure (RR 2.9; 95% CI 2.3–3.7), CVA (RR 1.7; 95% CI 1.2–2.6) and hospitalisation due to CVD (RR 1.6; 95% CI 1.3–1.9) when compared with women with subsequent uncomplicated pregnancies. Other studies on thromboembolism, atherosclerosis and cardiovascular mortality found a positive effect, but data could not be pooled.ConclusionsThis systematic review and meta‐analysis support consistent higher risk for future development of hypertension and CVD in women with recurring pre‐eclampsia as opposed to women with a single episode of pre‐eclampsia.Tweetable abstractThe risk of future cardiovascular disease increases when women have recurrence of pre‐eclampsia compared with a single episode.

Hypertensive Disorders of Pregnancy and Future Cardiovascular Health

“…Not surprising the prevalence of ischemic heart disease in formerly PE women is significantly higher than in parous controls with an uneventful pregnancy (1, 101) ( Figure 1). As well as it has been demonstrated in chronic hypertension, this higher risk of developing coronary artery disease in women who had HDP show a "dose dependent effect, ", being higher in the presence of a more severe disease in pregnancy, in the case of associated fetal growth abnormalities and iatrogenic preterm birth and if PE recurred in subsequent pregnancies (55,94) (Figures 2, 3). Moreover, the association was not explained by adjustment for confounding variables, although it was attenuated by the presence of other CV risk factors (55,94).…”

“…Brouwers et al have demonstrated that subjects with recurrent PE had a higher risk of future essential hypertension than formerly PE women with a successive unaffected gestation (RR 2.3, 95% CI 1.9 to 2.9) (94). The relation between HDP, future occurrence of essential hypertension and other pre-pregnancy CV risk has also been assessed to try and isolate the effect of pregnancy on this outcome.…”

Low antithrombin activity before delivery predicts subsequent hypertensive disorders in pregnancy

“…However, we disagree with van Oostwaard et al's 18 comments that "among women that experience hypertension in pregnancy, the recurrence rate in a next pregnancy is relatively low," because one out of five women (20.7%) experienced HDP recurrence in their analysis. Previous studies have reported recurrence rates of pre-eclampsia varying from 6.8% to 58%, [3][4][5][6][7][8][9][10][11] with a median of approximately 20%. In the present study, the recurrence rate of HDP and preeclampsia was 25.0% and 6.7%, respectively.…”

Impact of Physical Activity During Pregnancy on Gestational Hypertension

“…Hypertensive disorders of pregnancy often lead to adverse pregnancy outcomes, of which preeclampsia accounts for 15% of preterm birth, increased maternal and fetus morbidity and mortality (Laura et al 2018). In addition, preeclampsia can lead to maternal risk of long-term CVD, and significantly increase chronic diseases risk such as hypertension, stroke, diabetes, and obesity in offspring (Parikh et al 2020).…”