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Long term cardiovascular risk in women with pre-eclampsia: systematic review and meta-analysis
  1. M C Brown1,
  2. K E Best1,
  3. R Bell1,
  4. M S Pearce1,
  5. S C Robson2,
  6. J Waugh3
  1. 1Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
  2. 2Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
  3. 3Directorate of Women's Services, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, UK

Abstract

Introduction There is increasing evidence that pre-eclampsia, a principal cause of maternal morbidity, may also be a risk factor for future cardiovascular and cerebrovascular events. This review aimed to assess the current evidence and quantify the risks of cardiovascular and cerebrovascular events that may follow a diagnosis of pre-eclampsia.

Methods MEDLINE and EMBASE were searched with no language restrictions, as were core journals and reference lists from reviews. Case control and cohort studies which reported cardiovascular and cerebrovascular diseases diagnosed more than 6 weeks postpartum, in women who had history of pre-eclampsia relative to women who had unaffected pregnancies, were included.

Results 24 articles were included in the systematic review and 19 in the meta-analysis. Women with a history of pre-eclampsia or eclampsia were at significantly increased odds of fatal or non-fatal cardiovascular disease (OR=2.27, 95% CI 1.83 to 2.82) and cerebrovascular disease (OR=2.46, 95% CI 1.57 to 3.85). Among pre-eclamptic women, pre-term delivery was not associated with an increased risk of a future cardiovascular event (relative risk=1.28, 95% CI 0.82 to 1.99).

Conclusion Women diagnosed with pre-eclampsia are at increased risk of future cardiovascular or cerebrovascular events, with an estimated doubling of risk compared to unaffected women. This has implications for the follow-up of all women who experience pre-eclampsia, not just those who deliver pre-term. This association may reflect shared common risk factors for both pre-eclampsia and cardiovascular and cerebrovascular disease.

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