Pre-eclampsia is associated with a twofold increase in diabetes: a systematic review and meta-analysis

Wu, Pensée; Kwok, Chun Shing; Haththotuwa, Randula; Kotronias, Rafail A.; Babu, Aswin; Fryer, Anthony A.; Myint, Phyo Kyaw; Chew-Graham, Carolyn A; Mamas, Mamas A.

doi:10.1007/s00125-016-4098-x

Cited by 53 publications

(48 citation statements)

References 43 publications

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“…Our results were generally consistent with previous studies in showing that women with HDP had adverse levels of cardiovascular risk factors at various time points from before first pregnancy and until menopause,6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 with correspondingly increased risks of hypertension, obesity, and diabetes mellitus 13, 14, 15, 39, 40, 41, 42. Our study adds to the limited evidence beyond age 50 years, confirming that except for lipids, for which trajectories converge by age 60 years, other differences in cardiovascular risk factors persist until age 60 years.…”

Section: Discussionsupporting

confidence: 92%

Life Course Trajectories of Cardiovascular Risk Factors in Women With and Without Hypertensive Disorders in First Pregnancy: The HUNT Study in Norway

Haug

Horn

Markovitz

et al. 2018

JAHA

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BackgroundWomen with hypertensive pregnancy disorders have adverse levels of cardiovascular risk factors. It is unclear how this adverse risk factor profile evolves during adult life. We compared life course trajectories of cardiovascular risk factors in women with preeclampsia or gestational hypertension in their first pregnancy to normotensive women.Methods and ResultsWe linked information on cardiovascular risk factors from the population‐based HUNT (Nord‐Trøndelag Health Study) surveys with pregnancy information from the Medical Birth Registry of Norway. Trajectories of cardiovascular risk factors were constructed for 22 308 women with a normotensive first pregnancy; 1092 with preeclampsia, and 478 with gestational hypertension in first pregnancy. Already before first pregnancy, women with preeclampsia in their first pregnancy had higher measures of adiposity, blood pressure, heart rate, and serum lipids and glucose compared with women with a normotensive first pregnancy. After first pregnancy, there was a parallel development in cardiovascular risk factor levels, but women with a normotensive first pregnancy had a time lag of >10 years compared with the preeclampsia group. There were no clear differences in risk factor trajectories between women with gestational hypertension and women with preeclampsia.ConclusionsWomen with hypertensive pregnancy disorders in their first pregnancy had an adverse cardiovascular risk factor profile before pregnancy compared with normotensive women, and the differences persisted beyond 50 years of age. Hypertensive disorders in pregnancy signal long‐term increases in modifiable cardiovascular risk factors, and may be used to identify women who would benefit from early prevention strategies.

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Section: Discussionsupporting

confidence: 92%

Life Course Trajectories of Cardiovascular Risk Factors in Women With and Without Hypertensive Disorders in First Pregnancy: The HUNT Study in Norway

Haug

Horn

Markovitz

et al. 2018

JAHA

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“…Preeclampsia has been found to be associated with a 3-fold risk of future hypertension 40 and a doubling in risk of future diabetes mellitus. 43 Therefore, heart failure in this group of women may be because of causes other than ischemic cardiomyopathy, for example, hypertensive heart disease or diabetic cardiomyopathy. It has been suggested that the left ventricular remodeling and hypertrophy seen during preeclamptic pregnancies continues after the pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Preeclampsia and Future Cardiovascular Health

Haththotuwa

Kwok

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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335

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P reeclampsia is a major cause of maternal mortality worldwide 1 and affects 2% to 8% of all pregnancies. 2,3 It is confined to pregnancy and defined as onset of hypertension after 20-week gestation with proteinuria, organ dysfunction, or uteroplacental dysfunction. 4 The pathogenesis of preeclampsia remains poorly understood and is thought to be because of the failure of spiral artery remodeling in the placenta causing placental hypoperfusion and hypoxia. The resultant oxidative stress triggers an excessive systemic inflammatory response, which causes endothelial dysfunction and vasoconstriction leading to systemic hypertension and end-organ hypoperfusion. 2,5 There is growing evidence that these effects on end organs persist after pregnancy.Cardiovascular disease is a leading cause of mortality globally and also of maternal death in the United Kingdom and United States. 6,7 Several studies have examined the relationship between preeclampsia and future incident cardiovascular disease, although the literature has been inconsistent. Some studies reported significantly higher risks of composite cardiovascular events or heart failure, 8,9 whereas others have not demonstrated such relationships. 10,11 It is unclear whether preeclampsia is an independent risk factor for future cardiovascular disease or an early marker of women with high-risk profiles for future cardiovascular disease. Factors that predispose women to preeclampsia are also found in the risk profile for cardiovascular diseases. These include obesity, 12 metabolic abnormalities, dyslipidemia, insulin resistance, 13 heightened inflammatory responses, hypercoagulable states, and endothelial dysfunction.14 Alternatively, the body may not fully recover from the damage to the Background-Preeclampsia is a pregnancy-specific disorder resulting in hypertension and multiorgan dysfunction. There is growing evidence that these effects persist after pregnancy. We aimed to systematically evaluate and quantify the evidence on the relationship between preeclampsia and the future risk of cardiovascular diseases. Methods and Results-We studied the future risk of heart failure, coronary heart disease, composite cardiovascular disease, death because of coronary heart or cardiovascular disease, stroke, and stroke death after preeclampsia. A systematic search of MEDLINE and EMBASE was performed to identify relevant studies. We used random-effects meta-analysis to determine the risk. Twenty-two studies were identified with >6.4 million women including >258 000 women with preeclampsia. Meta-analysis of studies that adjusted for potential confounders demonstrated that preeclampsia was independently associated with an increased risk of future heart failure (risk ratio ). Conclusions-Preeclampsia is associated with a 4-fold increase in future incident heart failure and a 2-fold increased risk in coronary heart disease, stroke, and death because of coronary heart or cardiovascular disease. Our study highlights the importance of lifelong monitoring of cardiovascular risk f...

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“…Preeclampsia (PE) and gestational diabetes mellitus (GDM) are common complications of pregnancy that are associated with increased risk of maternal type 2 diabetes (T2DM) [1,2] and cardiovascular disease (CVD) later in life [3,4]. The global prevalence of PE is around 5% [5], while in Norway it is stable at around 3% [6].…”

Section: Introductionmentioning

confidence: 99%

Implementing a healthy postpartum lifestyle after gestational diabetes or preeclampsia: a qualitative study of the partner’s role

Almli

Haugdahl

Sandsæter

et al. 2020

BMC Pregnancy Childbirth

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Background: Women with preeclampsia (PE) and gestational diabetes mellitus (GDM) are at increased risk for later cardiovascular disease, and lifestyle measures are recommended to prevent subsequent disease. Partner support has been shown to be important in lifestyle modification in other diseases, but there is a lack of knowledge of partner involvement in PE and GDM. The aim of this study was to explore the partner's experiences and knowledge of gestational diseases, and how the partner wishes to contribute to lifestyle change. Methods: A qualitative study with one focus group interview and seven in-depth individual interviews, involving eleven partners of women with a pregnancy complicated by GDM or PE. The interview data were inductively analysed using four-step systematic text condensation, supported by interdependence theory. Results: Partners experienced a strong "we-feeling" and wanted to support the woman in lifestyle changes. At the same time, they felt insecure, worried, foolish and left out and they missed information from clinicians. The partners felt that their involvement was crucial to lasting lifestyle changes and expected that the clinicians would routinely invite them to discuss lifestyle change. Conclusions: Partners considered themselves an important resource for lifestyle changes for women with PE and GDM, but missed being more directly invited, informed and included in maternity care and wanted to participate in the care that followed the gestational disease. This study can help health professionals to realize that partners are an overlooked resource that can make important contributions to improve the health of the whole family if they are involved and supported by health services.

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Pre-eclampsia is associated with a twofold increase in diabetes: a systematic review and meta-analysis

Cited by 53 publications

References 43 publications

Life Course Trajectories of Cardiovascular Risk Factors in Women With and Without Hypertensive Disorders in First Pregnancy: The HUNT Study in Norway

Life Course Trajectories of Cardiovascular Risk Factors in Women With and Without Hypertensive Disorders in First Pregnancy: The HUNT Study in Norway

Preeclampsia and Future Cardiovascular Health

Implementing a healthy postpartum lifestyle after gestational diabetes or preeclampsia: a qualitative study of the partner’s role

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