Clinical InvestigationWomen's HealthCardiovascular sequelae of preeclampsia/eclampsia: A systematic review and meta-analyses
Section snippets
Background
Preeclampsia is one of the most common complications of pregnancy, affecting 3% to 5% of gestations. It is defined as the onset of hypertension and proteinuria after 20 weeks gestation.1 Eclampsia, the concomitant development of seizures, is a rare complication of preeclampsia in the developed world (with an incidence of 1 in 2,000 gestations2) but remains relatively common elsewhere (0.93%3). Preeclampsia/eclampsia is thought to originate from reduced uteroplacental perfusion that develops as
Methods
We followed the MOOSE (Meta-analysis of Observational Studies in Epidemiology) consensus statement on the conduct of meta-analysis of observational studies.14
Description of studies
Four hundred ninety nonduplicate titles and abstracts were identified in our search (Figure 1). Based on our screening process, 66 citations were selected to undergo full-text article review. The most common reasons for exclusion were study design and failure to report any cardiovascular outcomes.
Five case-control studies19, 20, 21, 22, 23 and 10 cohort studies17, 18,24, 25, 26, 27, 28, 29, 30, 31 were included, involving a total of 118,990 women with a history of preeclampsia/eclampsia and
Discussion
We determined that women with a history of preeclampsia/eclampsia have approximately double the risk of subsequent cardiac disease compared to women with uncomplicated pregnancies even after controlling for many confounders. Similarly increased risks of long-term cerebrovascular and peripheral arterial diseases and cardiovascular mortality among women with preeclampsia/eclampsia were also found. The meta-regression may suggest a “dose-response,” with higher risks of CVD noted in women with a
References (46)
- et al.
Pathogenesis and genetics of pre-eclampsia
Lancet
(2001) - et al.
The myometrial junctional zone spiral arteries in normal and abnormal pregnancies: a review of the literature
Am J Obstet Gynecol
(2002) - et al.
Pre-eclampsia and thrombophilia
Best Pract Res Clin Obstet Gynaecol
(2003) - et al.
Relative glucose tolerance and subsequent development of hypertension in pregnancy
Obstet Gynecol
(2001) - et al.
Meta-analysis in clinical trials
Control Clin Trials
(1986) - et al.
Cardiovascular and thromboembolic events following hypertensive pregnancy
Am J Kidney Dis
(2003) - et al.
Risk for subsequent coronary artery disease after preeclampsia
Am J Cardiol
(2004) - et al.
Pregnancy complications and maternal risk of ischaemic heart disease: a retrospective cohort study of 129,290 births
Lancet
(2001) - et al.
Cardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study
Lancet
(2005) - et al.
Pre-eclampsia and cardiovascular disease: metabolic syndrome of pregnancy
Atherosclerosis
(2004)
Severe preeclampsia-eclampsia in young primigravid women: subsequent pregnancy outcome and remote prognosis
Am J Obstet Gynecol
Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study
Lancet
Eclampsia in the United Kingdom
BMJ
World Health Organization International Collaborative Study of Hypertensive Disorders of Pregnancy
Am J Obstet Gynecol
Pathophysiology of hypertension during preeclampsia linking placental ischemia with endothelial dysfunction
Hypertension
Vascular changes in the decidua associated with eclamptogenic toxemia of pregnancy
Am J Clin Pathol
Dysmetabolic syndrome, placenta-mediated disease and future risk of cardiovascular disease
Fetal Matern Med Rev
Maternal body mass index and the risk of preeclampsia: a systematic overview
Epidemiology
Endothelial dysfunction in preeclampsia
Semin Reprod Endocrinol
Association of maternal endothelial dysfunction with preeclampsia
JAMA
Remote prognosis after eclampsia
Perspect Nephrol Hypertens
Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group
JAMA
Measuring inconsistency in meta-analyses
BMJ
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Intrapartum trends of NT-proBNP and hs-cTnT in patients with severe features of preeclampsia
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2024, American Journal of Obstetrics and Gynecology MFMPostpartum care in a cardio-obstetric clinic after preterm preeclampsia: patient and healthcare provider perspectives
2024, American Journal of Obstetrics and Gynecology MFMAssociation between depression and stroke and the role of sociodemographic factors: A study among hypertensive populations
2023, Journal of Stroke and Cerebrovascular DiseasesHypertensive disorders of pregnancy and long-term risk of maternal stroke—a systematic review and meta-analysis
2023, American Journal of Obstetrics and Gynecology
This study was supported by the Regional Medical Association Scholarship Fund of Hamilton Health Sciences. Dr Yusuf holds the Heart and Stroke Foundation Chair in Cardiology. Dr Devereaux is supported by a Canadian Institutes of Health Research New Investigator Award.