Future cardiovascular disease risk for women with gestational hypertension: a systematic review and meta-analysis

Charmaine Chu Wen Lo, Andre C Q Lo, Shu Hui Leow, Grace Fisher, Beth Corker, Olivia Batho, Bethan Morris, Monika Chowaniec, Catherine J. Vladutiu, Abigail Fraser, Clare Oliver-Williams*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Background
Inconsistent findings have been found among studies evaluating the risk of cardiovascular disease for women who have had pregnancies complicated by gestational hypertension (the new onset of high blood pressure without proteinuria during pregnancy). We provide a comprehensive review of studies to quantify the association between gestational hypertension and cardiovascular events in women.

Methods and Results
We conducted a systematic search of PubMed, Embase, and Web of Science in March 2019 for studies examining the association between gestational hypertension and any cardiovascular event. Two reviewers independently assessed the abstracts and full‐text articles. Study characteristics and the relative risk (RR) of cardiovascular events associated with gestational hypertension were extracted from the eligible studies. Where appropriate, the estimates were pooled with inverse variance weighted random‐effects meta‐analysis. A total of 21 studies involving 3 60 1192 women (127 913 with gestational hypertension) were identified. Gestational hypertension in the first pregnancy was associated with a greater risk of overall cardiovascular disease (RR, 1.45; 95% CI, 1.17–1.80) and coronary heart disease (RR, 1.46; 95% CI, 1.23–1.73), but not stroke (RR, 1.26; 95% CI, 0.96–1.65) or thromboembolic events (RR, 0.88; 95% CI, 0.73–1.07). Women with 1 or more pregnancies affected by gestational hypertension were at greater risk of cardiovascular disease (RR, 1.81; 95% CI, 1.42–2.31), coronary heart disease (RR, 1.83; 95% CI, 1.33–2.51), and heart failure (RR, 1.77; 95% CI, 1.47–2.13), but not stroke (RR, 1.50; 95% CI, 0.75–2.99).

Conclusions
Gestational hypertension is associated with a greater risk of overall cardiovascular disease, coronary heart disease, and heart failure. More research is needed to assess the presence of a dose–response relationship between gestational hypertension and subsequent cardiovascular disease.
Original languageEnglish
Number of pages36
JournalJournal of the American Heart Association
Volume9
Issue number13
Early online date24 Jun 2020
DOIs
Publication statusPublished - 7 Jul 2020

Keywords

  • Women
  • Risk Factors
  • Pregnancy
  • Epidemiology
  • Hypertension
  • Metaanalysis

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