Preeclampsia and cancer risk in women in later life: a systematic review and meta-analysis of cohort studies

Wang, Fengxia; Zhang, Wenyan; Cheng, Wenke; Huo, Nana; Zhang, Shenfeng

doi:10.1097/gme.0000000000001806

Cited by 16 publications

(13 citation statements)

References 30 publications

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“…For cognitive outcomes, it remains uncertain if there is a difference between early-onset and late-onset pre-eclampsia 302 . An effect of pre-eclampsia on malignancies has recently been identified 307 .…”

Section: Long-term Health Outcomesmentioning

confidence: 99%

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Pre-eclampsia

Dimitriadis

Rolnik

Zhou

et al. 2023

Nat Rev Dis Primers

278

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Pre-eclampsia is a life-threatening disease of pregnancy unique to humans and a leading cause of maternal and neonatal morbidity and mortality. Women who survive pre-eclampsia have reduced life expectancy, with increased risks of stroke, cardiovascular disease and diabetes, while babies from a pre-eclamptic pregnancy have increased risks of preterm birth, perinatal death and neurodevelopmental disability and cardiovascular and metabolic disease later in life. Preeclampsia is a complex multisystem disease, diagnosed by sudden-onset hypertension (>20 weeks of gestation) and at least one other associated complication, including proteinuria, maternal organ dysfunction or uteroplacental dysfunction. Pre-eclampsia is found only when a placenta is or was recently present and is classified as preterm (delivery <37 weeks of gestation), term (delivery ≥37 weeks of gestation) and postpartum pre-eclampsia. The maternal syndrome of pre-eclampsia is driven by a dysfunctional placenta, which releases factors into maternal blood causing systemic inflammation and widespread maternal endothelial dysfunction. Available treatments target maternal hypertension and seizures, but the only 'cure' for pre-eclampsia is delivery of the dysfunctional placenta and baby, often prematurely. Despite decades of research, the aetiology of pre-eclampsia, particularly of term and postpartum pre-eclampsia, remains poorly defined. Significant advances have been made in the prediction and prevention of preterm pre-eclampsia, which is predicted in early pregnancy through combined screening and is prevented with daily low-dose aspirin, starting before 16 weeks of gestation. By contrast, the prediction of term and postpartum pre-eclampsia is limited and there are no preventive treatments. Future research must investigate the pathogenesis of pre-eclampsia, in particular of term and postpartum pre-eclampsia, and evaluate new Nature Reviews Disease Primers | (2023) 9:8 2 0123456789();: Primer Epidemiology Incidence and mortalityThe global prevalence of all pre-eclampsia in the years 2002-2010 was estimated at 4.6% of deliveries but reported regional rates varied between 1% and 5.6% 14 . Where reported, the prevalence of preterm pre-eclampsia is <1% [15][16][17][18] . The prevalence of pre-eclampsia is generally reported as lower in low-income and middle-income countries (LMICs) (except sub-Saharan Africa) than in high-income countries (HICs) 19,20 ; however, it is likely that differences in classification, access to prenatal care and under-reporting in LMICs affect prevalence data 20,21 . Furthermore, most pre-eclampsia research is performed in HICs, potentially leading to bias and generalizability concerns in the populations sampled and the research questions asked.Hypertensive disorders of pregnancy (including pre-eclampsia) are the second most common cause (behind haemorrhage) of maternal Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rights...

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Section: Long-term Health Outcomesmentioning

confidence: 99%

“…In a meta-analysis of >5 million women, a history of pre-eclampsia was associated with a lower risk of breast cancer (RR 0.88, 95% CI 0.83-0.93) and increased risk of ovarian cancer (RR 1.82, 95% CI 1.16-2.85) 307 .…”

Section: Long-term Health Outcomesmentioning

confidence: 99%

Pre-eclampsia

Dimitriadis

Rolnik

Zhou

et al. 2023

Nat Rev Dis Primers

278

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“…A population study also demonstrated no association between antiangiogenic factor levels during pregnancy and risk of breast cancer in the first decade after delivery (27). However, in a recently published meta-analysis that included 13 cohort studies comprising 5,254,150 participants, women with preeclampsia had a lower incidence of breast cancer than women without preeclampsia (28). One possible mechanism for this reduced risk of breast cancer is hormonal changes and responsiveness to hormones.…”

Section: Discussionmentioning

confidence: 99%

The Risk Factors, Incidence and Prognosis of Postpartum Breast Cancer: A Nationwide Study by the SMARTSHIP Group

Park

Lee²,

Yoon³

et al. 2022

Front. Oncol.

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The term ‘pregnancy-associated breast cancer’ is no longer used as it has been consistently reported that breast cancer during pregnancy and breast cancer after delivery (postpartum breast cancer) have different characteristics and prognosis. The purpose of this study is to define postpartum breast cancer by analyzing the incidence rate, related factors, and prognosis according to the timing of breast cancer. Data from the Korean National Health Insurance Service were used to analyze 1,292,727 women aged 20-49 years who birthed their first child between 2007 and 2012. The annual incidence rate of breast cancer after delivery increased every year (7.7 per 10,000 person-years after 5 years, 19.36 per 10,000 person-years after 10 years). The risk of breast cancer was significantly higher (hazard ratio 1.15, 95% CI 1.05-1.27, P=0.0037) in women diagnosed with gestational diabetes, but that was not associated with overall survival (OS). Patients diagnosed with breast cancer within 5 years of delivery had a poorer prognosis than those diagnosed later (5-year OS, <5 years: 91.1% vs. 5-10 years: 96.0%). In multivariate analysis of OS, the hazard ratio of patients diagnosed within 5 years after delivery was twice as high as of patients diagnosed between 5 and 10 years. Women diagnosed with gestational diabetes had an increased risk of breast cancer. Breast cancer patients diagnosed within 5 years of delivery had a poorer prognosis than those diagnosed later. In this regard, careful screening for early diagnosis of high-risk patients and intensive research on new treatment strategies are needed.

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“…Certain pregnancy complications also may be associated with subsequent maternal breast cancer risk, for example preeclampsia, but because these conditions are rare, the investigations require large studies like the Nordic Project to reach the statistical precision required for accuracy. Several studies have shown a reduced risk of breast cancer among women with a history of preeclampsia, a hypertensive disorder of pregnancy, compared with those with normotensive pregnancies (17). Interestingly, one study demonstrated a marked reduction with elevated mean arterial pressure (MAP) (18) and with systolic blood pressure increasing from mid-to late pregnancy below the diagnostic criterion for hypertension (i.e., in normotensive pregnancies) (19).…”

Section: Breast Cancermentioning

confidence: 99%