Preventing cardiovascular disease after hypertensive disorders of pregnancy: Searching for the how and when

Abstract

Background Women with a history of a hypertensive disorder during pregnancy (HDP) have an increased risk of cardiovascular events. Guidelines recommend assessment of cardiovascular risk factors in these women later in life, but provide limited advice on how this follow-up should be organized. Design Systematic review and meta-regression analysis. Methods The aim of our study was to provide an overview of existing knowledge on the changes over time in three major modifiable components of cardiovascular risk assessment after HDP: blood pressure, glucose homeostasis and lipid levels. Data from 44 studies and up to 6904 women with a history of a HDP were compared with risk factor levels reported for women of corresponding age in the National Health And Nutrition Examination Survey, Estudio Epidemiólogico de la Insuficiencia Renal en España and Hong Kong cohorts ( N = 27,803). Results Compared with the reference cohort, women with a HDP presented with higher mean blood pressure. Hypertension was present in a higher rate among women with a previous HDP from 15 years postpartum onwards. At 15 years postpartum (±age 45), one in five women with a history of a HDP suffer from hypertension. No differences in glucose homeostasis parameters or lipid levels were observed. Conclusions Based on our analysis, it is not possible to point out a time point to commence screening for cardiovascular risk factors in women after a HDP. We recommend redirection of future research towards the development of a stepwise approach identifying the women with the highest cardiovascular risk.

Keywords: Pregnancy; cardiovascular diseases; hypertension; pre-eclampsia; pregnancy-induced; preventive medicine.

Figure 1.

Flowchart (last search 20 October 2015). HDP: hypertensive disorder during pregnancy

Figure 2.

(a) Weighted mean blood pressure. (b) Prevalence of hypertension. Sample sizes are shown below the x-axis. Ranges or standard deviations are missing in the plots, since these are not reported in the NHANES manuscript. NHANES: National Health And Nutrition Examination Survey

Figure 3.

(a) Weighted mean fasting glucose. (b) Homeostasis model assessment of insulin resistance. (c) Weighted mean high-density lipoprotein cholesterol. (d) Weighted mean low-density lipoprotein cholesterol. Sample sizes are shown below the x-axis. NHANES: National Health And Nutrition Examination Survey; ATP III: Third Adult Treatment Panel