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Future Cardiovascular Disease Risk for Women With Gestational Hypertension: A Systematic Review and Meta-Analysis.

Accepted version
Peer-reviewed

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Type

Article

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Authors

Lo, Charmaine Chu Wen 
Lo, Andre CQ 
Leow, Shu Hui 
Fisher, Grace 
Corker, Beth 

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. Registration URL: https://www.crd.york.ac.uk/prosp​ero/; Unique identifier: CRD42018119031.

Description

Keywords

cardiovascular disease, gestational hypertension, pregnancy, review, women, Adolescent, Adult, Blood Pressure, Cardiovascular Diseases, Coronary Disease, Female, Heart Disease Risk Factors, Heart Failure, Humans, Hypertension, Pregnancy-Induced, Middle Aged, Pregnancy, Prognosis, Risk Assessment, Young Adult

Journal Title

J Am Heart Assoc

Conference Name

Journal ISSN

2047-9980
2047-9980

Volume Title

9

Publisher

Ovid Technologies (Wolters Kluwer Health)

Rights

All rights reserved
Sponsorship
British Heart Foundation (None)
CO is was supported by a British Heart Foundation Cambridge Centre of Excellence (RE/13/6/30180) and an early career fellowship from Homerton College, University of Cambridge. AF is supported by a UK MRC fellowship (MR/M009351/1). The funding source had no role in the design or conduct of the study; collection or analysis of the data; or the decision to submit the manuscript for publication