Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis

Abstract

Objective To quantify the risk of future cardiovascular diseases, cancer, and mortality after pre-eclampsia. Design Systematic review and meta-analysis. Data sources Embase and Medline without language restrictions, including papers published between 1960 and December 2006, and hand searching of reference lists of relevant articles and reviews for additional reports. Review methods Prospective and retrospective cohort studies were included, providing a dataset of 3 488 160 women, with 198 252 affected by pre-eclampsia (exposure group) and 29 495 episodes of cardiovascular disease and cancer (study outcomes). Results After pre-eclampsia women have an increased risk of vascular disease. The relative risks (95% confidence intervals) for hypertension were 3.70 (2.70 to 5.05) after 14

Hypertensive Disorders of Pregnancy and Future Maternal Cardiovascular Risk

“…More specifically, one meta‐analysis demonstrated a 4.2‐fold increased risk of heart failure, a 2.5‐fold increased risk of coronary artery disease, and a 1.8‐fold increased risk of stroke in women with preeclamptic pregnancies over a follow‐up period of up to 39 years 42. The risk of future hypertension is even more pronounced, with increased risk ranging from 2.3‐ to 6.7‐fold among women with prior preeclampsia 38, 40, 43, 44. These women also have roughly double the risk of venous thromboembolism and 4 times the risk of DM compared with those with normotensive pregnancies 38, 45.…”

“…Notably, a dose‐response relationship has been observed between the severity of preeclampsia and the long‐term risk of CVD 41, 43, 45. In a meta‐analysis of >2.3 million women, mild, moderate, and severe preeclampsia was associated with relative risk of 2.00, 2.99, and 5.36, respectively, of developing future CVD 41.…”

Do Young Women Need Treatment for Hypertension After Pregnancy Complications?

“…Studies of women from 1 to 40 years after childbirth consistently show increased rates of hypertension, ischemic heart disease, cerebrovascular disease, and cardiovascular mortality following a hypertensive pregnancy 1, 2. There is also evidence of a dose response according to the severity of hypertension during pregnancy.…”

“…Pregnancy complications, such as hypertensive disorders of pregnancy, are well established as independent risk factors for cardiovascular diseases in later life in both the mother1, 2 and the offspring 3, 4. Studies of women from 1 to 40 years after childbirth consistently show increased rates of hypertension, ischemic heart disease, cerebrovascular disease, and cardiovascular mortality following a hypertensive pregnancy 1, 2.…”

Impact of a History of Hypertension in Pregnancy on Later Diagnosis of Atrial Fibrillation

“…Women with a history of a hypertensive pregnancy disorder (HPD) are ≈4 times more likely to develop hypertension later in life,4, 5 and also develop hypertension ≈10 years earlier than women who have had normotensive pregnancies 6. Hypertension in pregnancy is common, occurring in up to 10% of pregnancies worldwide,7 and may be increasing in prevalence 8.…”