Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis

Abstract

Objective: To quantify the risk of future cardiovascular diseases, cancer, and mortality after pre-eclampsia.

Design: Systematic review and meta-analysis.

Data sources: Embase and Medline without language restrictions, including papers published between 1960 and December 2006, and hand searching of reference lists of relevant articles and reviews for additional reports.

Review methods: Prospective and retrospective cohort studies were included, providing a dataset of 3,488,160 women, with 198,252 affected by pre-eclampsia (exposure group) and 29,495 episodes of cardiovascular disease and cancer (study outcomes).

Results: After pre-eclampsia women have an increased risk of vascular disease. The relative risks (95% confidence intervals) for hypertension were 3.70 (2.70 to 5.05) after 14.1 years weighted mean follow-up, for ischaemic heart disease 2.16 (1.86 to 2.52) after 11.7 years, for stroke 1.81 (1.45 to 2.27) after 10.4 years, and for venous thromboembolism 1.79 (1.37 to 2.33) after 4.7 years. No increase in risk of any cancer was found (0.96, 0.73 to 1.27), including breast cancer (1.04, 0.78 to 1.39) 17 years after pre-eclampsia. Overall mortality after pre-eclampsia was increased: 1.49 (1.05 to 2.14) after 14.5 years.

Conclusions: A history of pre-eclampsia should be considered when evaluating risk of cardiovascular disease in women. This association might reflect a common cause for pre-eclampsia and cardiovascular disease, or an effect of pre-eclampsia on disease development, or both. No association was found between pre-eclampsia and future cancer.

Fig 1 Study selection process

Fig 2 Pre-eclampsia and risk of hypertension in later life

Fig 3 Pre-eclampsia and risk of fatal and non-fatal ischaemic heart disease events in later life. *Early and late pre-eclampsia combined (see table 2). †Mild and severe pre-eclampsia combined (see table 2). ‡All maternal placental syndromes

Fig 4 Pre-eclampsia and risk of ischaemic heart disease in later life by study characteristics. *Only one study included, as data not available from Smith 2001^w16

Fig 5 Pre-eclampsia and risk of fatal and non-fatal stroke and thromboembolism in later life. *Early and later pre-eclampsia combined. †Fatal and non-fatal stroke combined. ‡Mild and severe pre-eclampsia combined

Fig 6 Pre-eclampsia and risk of breast cancer or any cancer in later life. *Early and late pre-eclampsia combined

Fig 7 Pre-eclampsia and risk of death from any cause in later life