Recurrence of Preeclampsia and the Risk of Future Hypertension and Cardiovascular Disease: A Systematic Review and Meta-Analysis

Abstract

Background Women with a history of hypertensive disorders, including pre-eclampsia, during pregnancy have a two-to-fivefold increased risk of cardiovascular disease (CVD). In 15% of women, pre-eclampsia recurs in the following pregnancy.Objectives To 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 strategy Embase and Medline were searched until June 2017.Selection criteria All 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 analysis Twenty-two studies were included in the review. When possible, we calculated pooled risk ratios (RR) with 95% CI through random-effect analysis.Main results Recurrent 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.Conclusions This 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.

Associations of polygenic risk scores for preeclampsia and blood pressure with hypertensive disorders of pregnancy

“…For example, chronic hypertension diagnosed before pregnancy is an independent risk factor for preeclampsia [4]. On the other hand, preeclampsia is associated with an increased risk of chronic hypertension and cardiovascular disease later in life [5,6]. Prior data suggest that this overlap may be partly driven by genetic factors, as chronic hypertension has been associated with several autosomal single nucleotide polymorphisms (SNPs) [7].…”

Practical guide for the management of hypertensive disorders during pregnancy

“…Preeclampsia is associated with long-term consequences following delivery and women suffer from future hypertension, ischemic heart disease, heart failure, stroke, and death [39][40][41][42].…”

Atualizações em pré-eclâmpsia - do diagnóstico ao tratamento

“…Na pré-eclâmpsia, a invasão trofoblástica, principalmente durante a 2ª onda, não ocorre de forma adequada e, consequentemente, há um aumento da resistência nas artérias espiraladas e uma redução do fluxo útero-placentário, causando isquemia ( ² 5) . Com a redução desse fluxo ocorre um gatilho, cuja origem ainda permanece desconhecida, que é responsável pela ativação endotelial, resultando em aumento do vasoespasmo, redução da permeabilidade capilar e ativação de alterações na cascata de coagulação ( ² 6-² 8) . Tais mecanismos são responsáveis pelos achados clínicos presentes na pré-eclâmpsia.…”

“…Eclâmpsia, acidente vascular cerebral hemorrágico, síndrome HELLP, insuficiência renal, edema agudo de pulmão, coagulopatias e insuficiência hepática estão entre os desfechos críticos. Ademais, essas mulheres ainda têm maiores risco de desenvolverem problemas de saúde futuros, como eventos cardiovasculares (insuficiência cardíaca, hipertensão, aterosclerose e cardi-opatia isquêmica), síndrome metabólica e diabetes (8)(9)(10) . Assim, vale ainda salientar, que a expectativa de vida para essas mulheres, em decorrência de uma pré-eclâmpsia prematura, é 10 anos a menos comparado a população geral, em média (7) .…”