Elsevier

American Heart Journal

Volume 156, Issue 5, November 2008, Pages 918-930
American Heart Journal

Clinical Investigation
Women's Health
Cardiovascular sequelae of preeclampsia/eclampsia: A systematic review and meta-analyses

https://doi.org/10.1016/j.ahj.2008.06.042Get rights and content

Background

Preeclampsia affects 3% to 5% of gestations and eclampsia 0.05% to 0.93%, but their subsequent cardiovascular sequelae are unclear. The aim of this study was to determine if women with a history of preeclampsia/eclampsia are at increased risk of long-term cardiovascular sequelae.

Methods

From Medline and Embase searches, we included case-control and cohort studies that examined cardiac, cerebrovascular or peripheral arterial disease, or cardiovascular mortality >6 weeks postpartum, in women with and without a history of preeclampsia/eclampsia and that controlled for or matched for confounders. Two independent reviewers determined study eligibility and extracted data.

Results

Five case-control and 10 cohort studies met eligibility criteria, with a total of 116,175 women with and 2,259,576 women without preeclampsia/eclampsia. Most studies focused on women <56 years of age. Relative to women with uncomplicated pregnancies, women with a history of preeclampsia/eclampsia had an increased risk of subsequent cardiac disease in both the case-control studies (odds ratio 2.47, 95% CI 1.22-5.01) and the cohort studies (relative risk [RR] 2.33, 1.95-2.78), as well as an increased risk of cerebrovascular disease (RR 2.03, 1.54-2.67), peripheral arterial disease (RR 1.87, 0.94-3.73), and cardiovascular mortality (RR 2.29, 1.73-3.04). Meta-regression revealed a graded relationship between the severity of preeclampsia/eclampsia and the risk of cardiac disease (mild: RR 2.00, 1.83-2.19, moderate: RR 2.99, 2.51-3.58, severe: RR 5.36, 3.96-7.27, P < .0001).

Conclusions

Women with a history of preeclampsia/eclampsia have approximately double the risk of early cardiac, cerebrovascular, and peripheral arterial disease, and cardiovascular mortality. Further research is needed to determine the mechanisms underlying these associations and to identify effective prevention strategies.

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

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  • Cited by (0)

    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.

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