Elsevier

Metabolism

Volume 102, January 2020, 154012
Metabolism

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

https://doi.org/10.1016/j.metabol.2019.154012Get rights and content

Highlights

  • 41 cohorts including 3300 pre-eclamptic (PE)/eclamptic(E) and 13967 normotensive controls were identified.

  • Women with previous PE have higher risks to develop hypertension and metabolic syndrome.

  • Body mass index, weight, waist and waist-to-hip ratio are higher in women who previously had PE.

  • Total cholesterol, LDL, triglycerides, CRP, glucose, insulin, and HOMA-IR are higher in women with history of PE.

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 >20 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/m2; 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.

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.

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