The Association Between Hypertensive Disorders in Pregnancy and the Risk of Developing Chronic Hypertension

Abstract

ObjectiveThis meta-analysis comprehensively evaluated the association between hypertensive disorders in pregnancy (HDP) and the risk of developing chronic hypertension and the associations between specific types of HDP, including preeclampsia (PE) and gestational hypertension (GH), and the risk of developing chronic hypertension.DesignSystematic review and meta-analysis.Data SourcesThe PubMed, Embase and Cochrane Library databases were searched from inception to August 20, 2021.MethodsDepending on heterogeneity, the combined odds ratio (OR) of the 95% confidence interval (CI) was obtained with a random-effects or fixed-effects model. We used meta-regression analysis to explore the sources of heterogeneity. We analyzed the OR value after adjusting for age and BMI at recruitment, prepregnancy BMI, age at first delivery, and other factors. Additionally, we evaluated the results of the subgroup analysis by the year of publication (< 2016, ≥ 2016), study design, sample size (< 500, ≥ 500), region (North and South America, Europe, and other regions) and NOS score (< 7, ≥ 7).ResultsOur systematic review and meta-analysis comprehensively explored the relationships between HDP, GH, and PE and chronic hypertension. Twenty-one articles that included 634,293 patients were included. The results of this systematic review and meta-analysis suggested that women with a history of HDP are almost 3.6 times more likely to develop chronic hypertension than those without a history of HDP, women with a history of GH are almost 6.2 times more likely to develop chronic hypertension than those without a history of GH, and women with a history of PE are almost 3.2 times more likely to develop chronic hypertension than those without a history of PE. In addition, we further calculated the probability of developing chronic hypertension among patients with HDP or PE after adjusting for age and BMI at recruitment, prepregnancy BMI, age at first delivery, and other factors. The results suggested that women with a history of HDP are almost 2.47 times more likely to develop chronic hypertension than those without a history of HDP and that women with a history of PE are almost 3.78 times more likely to develop chronic hypertension than those without a history of PE. People in Asian countries are more likely to develop chronic hypertension after HDP or PE, while American people are not at high relative risk.ConclusionThese findings suggest that HDP, GH, and PE increase the likelihood of developing chronic hypertension. After adjustment for age and BMI at recruitment, prepregnancy BMI, age at first delivery, and other factors, patients with HDP or PE were still more likely to develop chronic hypertension. HDP may be a risk factor for chronic hypertension, independent of other risk factors. GH and PE, as types of HDP, may also be risk factors for chronic hypertension.Systematic Review Registration[www.ClinicalTrials.gov], identifier [CRD42021238599].

Association between preterm delivery and subsequent maternal risk of hypertension and type 2 diabetes mellitus in a UK population-based retrospective cohort study

“…Furthermore, hypertensive disorders of pregnancy and gestational diabetes are established risk factors for future risk of corresponding chronic health conditions 22 49 50. The results of this study showed a strong association in the fully adjusted model (online supplemental table S4; HDP with hypertension, aHR 5.05, 95%CI 3.16 to 8.07; GDM with T2DM, aHR 18.80, 95%CI 12.05 to 29.35).…”

Association between pregnancy-related complications and development of type 2 diabetes and hypertension in women: an umbrella review

“…These were GDM and hypertensive disorders of pregnancy (including chronic hypertension, gestational hypertension, preeclampsia, eclampsia and HELLP syndrome). Additional file 1 : Table S8 [ 14 – 17 , 112 – 117 ] includes the definitions of the exposures and the extent of other confounders adjusted for in the reviews included. The number of women included in the systematic reviews ranged between 1,332,373 and 3,095,457 for studies relating to postpartum T2DM while for hypertension it was between 8041 and 2,711,443 (Table 2 ).…”

“… Hypertensive disorders of pregnancy (gestational hypertension and preeclampsia, not chronic hypertension.) Women with prior normotensive pregnancies, preeclampsia without severe features, or late-onset preeclampsia (developed after 34 completed weeks of gestation) depending on individual included studies Women with history of pregnancy (215,528) Hypertension Cohort (37) Newcastle–Ottawa Scale Thailand Science Research and Innovation (TSRI) Research Career Development Grant and Prince of Songka University High Xu 2022 [ 112 ] Brazil, Britain, China, France, Japan, Jordan, The Netherlands, Pakistan, Spain, Sweden, USA To comprehensively evaluate the association between hypertensive disorders in pregnancy and the risk of developing chronic hypertension. Hypertensive disorders of pregnancy or with the specific types of gestational hypertension and preeclampsia Women without hypertensive disorders of pregnancy or specific types of preeclampsia and gestational hypertension Women with history of pregnancy (hypertensive disorders of pregnancy as exposure = 228,317, preeclampsia as exposure = 341,060, gestational hypertension as exposure = 933) Hypertension Hypertensive disorders of pregnancy Cohort (5) Case–control (5) Cross-sectional (1) Gestational hypertension; cohort (1) Case–control (2) Preeclampsia; cohort (10) Case–control (3) Newcastle–Ottawa Scale National Natural Science Foundation of China High Vounzoulaki 2020 [ 114 ] Australia, Canada, Finland, France, Hungary, India, Iran, Israel, Italy, Korea, Pakistan, Spain, Sri Lanka, Sweden, UK, USA To estimate and compare progression rates to type 2 diabetes mellitus (T2DM) in women with gestational diabetes mellitus (GDM) and healthy controls Gestational diabetes mellitus Women with normoglycemic pregnancy Women with history of pregnancy (1,332,373) T2DM Cohort (20) Newcastle–Ottawa Scale National Institute for Health Research High Zhao 2021 [ 115 ] Australia, Canada, Denmark, Finland, Netherlands, Norway, Sweden, Taiwan, UK, USA To quant...…”

Research hotspots and thematic trends in the management of pre-eclampsia: a bibliometric analysis from 2000 to 2022

“…Researchers are gradually focusing on patients with hypertension but not enough to diagnose PE while studying the eld of PE management; for example, hypertension in pregnancy has a higher risk of developing chronic hypertension in the postpartum period relative to PE [44] . While studying PE, FGR as a complication of PE has often received attention during PE management [45] .…”