Meta-analysisEffects of preeclampsia and eclampsia on maternal metabolic and biochemical outcomes in later life: a systematic review and meta-analysis
Introduction
Hypertensive disorders of pregnancy (HDP) are a heterogeneous group of syndromes affecting 3–10% of pregnancies, and include preeclampsia (PE), eclampsia (E), gestational hypertension, and pre-gestational hypertension [1,2]. PE and E have as a common definition the presence of new onset hypertension and proteinuria diagnosed during the second half (> 20 weeks) of pregnancy. E is associated with tonic-clonic seizures and general complications in a woman with or without preeclampsia. Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is a rare complication of PE/E which may be accompanied of fatigue, edema, headache, nausea, abdominal pain, visual alterations, hemorrhage, intravascular coagulation, kidney failure and placental abruption [1,2].
PE/E have negative consequences on maternal and fetal health during pregnancy, including increased perinatal mortality, preterm births, small for gestational age infants, high rate of cesarean deliveries, and other adverse outcomes even at later postnatal periods [[3], [4], [5], [6]]. PE/E are associated with elevated blood pressure, inflammation and endothelial dysfunction, and these findings may remain after delivery and contribute to future maternal cardiovascular risk [[7], [8], [9], [10], [11]]. Furthermore, two recent meta-analyses reported that PE was independently associated with higher risk of future diabetes and cardiovascular events [12,13]. In particular, PE increased the risk of future diabetes (risk ratio [RR] 2.37, 95% confidence interval [CI] 1.89, 2.97) appearing in women as early as during 1 year postpartum (RR 1.97, 95% CI 1.35, 2.87) and persisting the risk up to 10 years after delivery (RR 1.95, 95% CI 1.28, 2.97) [12]. PE was also independently associated with higher risk of future heart failure (RR 4.19, 95% CI 2.09–8.38), coronary heart disease (RR 2.50, 95% CI 1.43–4.37), cardiovascular disease death (RR 2.21, 95% CI 1.83–2.66), and stroke (RR 1.81, 95% CI 1.29–2.55) [13]. Risks persisted after different confounder adjustments.
We systematically evaluated the association between PE/E and metabolic and biochemical outcomes from observational studies with intermediate and long term of follow up.
Section snippets
Methods
This systematic review was reported according to the Meta-Analysis Of Observational Studies in Epidemiology (MOOSE) Group guidelines [14]. Formal institutional review board approval was not required as this manuscript only addresses data extracted from already published studies.
Selection of studies
A total of 2671 abstracts were identified through search engine and 14 additional full-papers were identified by manual search. After removal of duplicates, 2022 items were evaluated, of which 1966 did not fulfill inclusion criteria. Hence, 56 full texts were assessed for eligibility. Nine papers did not report separated information of PE/E patients, five reported duplicate information, and one was a cross-sectional study (Fig. 1). Finally, a total of 41 full papers [[23], [24], [25], [26], [27]
Main findings
We found that women with PE/E or HELLP syndrome in comparison to women with normotensive pregnancies had later in life (i) higher hypertension risk and BP levels; (ii) higher BMI, waist circumference, waist-to-hip ratio, and weight, (iii) higher levels of total cholesterol, LDL, and triglycerides and lower levels of HDL; (iv) higher levels of serum glucose, insulin, the HOMA-IR index, C reactive protein, and (v) higher risk of MetS. These results were based in cohort studies with low risk of
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author contributions
FRPL and AVH were involved in study conception and design; acquisition, and interpretation of data; drafting of the manuscript; and approval the final version of the manuscript.
VAV, YL, VP, and YMR were involved in acquisition and interpretation of data; and approval of the final version of the manuscript.
YL and AVH performed statistical analyses.
FRPL and AVH have access to the data and are responsible for the accuracy of the manuscript.
Declaration of competing interest
The authors declared no conflict of interest.
References (79)
- et al.
Hypertensive complications of pregnancy: a clinical overview
Metab Clin Exp
(2018) - et al.
Short-term and long-term implications
Obstet Gynecol Clin North Am
(2015) - et al.
The classification, diagnosis and management of the hypertensive disorders of pregnancy: a revised statement from the ISSHP
Pregnancy Hypertens.
(2014) - et al.
The management of hypertension in pregnancy
Adv Chronic Kidney Dis
(2013) - et al.
Effect of early-onset preeclampsia on cardiovascular risk in the fifth decade of life
Am J Obstet Gynecol.
(2017) - et al.
Remote prognosis of preeclampsia in women 25 years old and younger
Am J Obstet Gynecol
(1988) - et al.
Preeclampsia and cardiovascular disease risk assessment - do arterial stiffness and atherosclerosis uncover increased risk ten years after delivery?
Pregnancy Hypertens
(2016) - et al.
Carotid artery intima-media thickness and subclinical atherosclerosis in women with remote histories of preeclampsia: results from a Rochester Epidemiology Project-Based Study and Meta-analysis
Mayo Clin Proc
(2017) - et al.
Measures of cardiovascular risk and subclinical atherosclerosis in a cohort of women with a remote history of preeclampsia
Atherosclerosis.
(2013) - et al.
Insulin resistance relates to microvascular reactivity 23 years after preeclampsia
Microvasc Res
(2010)
A systematic review and meta-analysis indicates long-term risk of chronic and end-stage kidney disease after preeclampsia
Kidney Int
Is maternal lipid profile in early pregnancy associated with pregnancy complications and blood pressure in pregnancy and long term postpartum?
Am J Obstet Gynecol.
Preeclampsia: clinical features and diagnosis. Uptodate 2019
ACOG Practice Bulletin No. 202: gestational hypertension and preeclampsia
Obstet Gynecol
Canadian Hypertensive Disorders of Pregnancy Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary
J Obstet Gynaecol Can
Perinatal outcome in singleton pregnancies complicated with preeclampsia and eclampsia in Ecuador
J Obstet Gynaecol
Management of hypertension in pregnant and postpartum women
Death rates from ischemic heart disease in women with a history of hypertension in pregnancy
Acta Obstet Gynecol Scand
Associations of pregnancy complications with calculated cardiovascular disease risk and cardiovascular risk factors in middle age: the Avon Longitudinal Study of Parents and Children
Circulation
Estimating rate of insulin resistance in patients with preeclampsia using HOMA-IR index and comparison with non-preeclampsia pregnant women
Biomed Res Int
Preeclampsia. Pathophysiology, challenges, and perspectives
Circ Res
Preeclampsia and future cardiovascular health: a systematic review and meta-analysis
Circ Cardiovasc Qual Outcomes
Pre-eclampsia is associated with a twofold increase in diabetes: a systematic review and meta-analysis
Diabetologia.
For the meta-analysis of observational studies in epidemiology (MOOSE) group. Meta-analysis of observational studies in epidemiology. A proposal for reporting
JAMA.
Maternal and neonatal outcome of patients classified according to the Australasian Society for the Study of Hypertension in Pregnancy Consensus Statement
Med J Aust
Estimating the mean and variance from the median, range, and the size of a sample
BMC Med Res Methodol
Commentary: heterogeneity in meta-analysis should be expected and appropriately quantified
Int J Epidemiol
Bias in metaanalysis detected by a simple, graphical test
BMJ.
Individual artery wall layer dimensions indicate increased cardiovascular risk in previous severe preeclampsia -an investigation using non-invasive high-frequency ultrasound
Pregnancy Hypertens.
Recurrence and long-term maternal health risks of hypertensive disorders of pregnancy: a population-based study
Am J Obstet Gynecol.
Persistence of cardiovascular risk factors in women with previous preeclampsia: a long-term follow-up study
J Invest Med
Microalbuminuria after pregnancy complicated by pre-eclampsia
Nephrol Dial Transplant
Does a predisposition to the metabolic syndrome sensitize women to develop pre-eclampsia?
J Hypertens
Shared constitutional risks for maternal vascular-related pregnancy complications and future cardiovascular disease
Hypertension.
Cardiovascular disease risk is only elevated in hypertensive, formerly preeclamptic women
BJOG
Fusi L, Malik IS, Haskard DO, De Swiet M, Kooner JS. Association of maternal endothelial dysfunction with preeclampsia
JAMA.
Skin autofluorescence as marker of tissue advanced glycation end-products accumulation in formerly preeclamptic women
Hypertens Pregnancy
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