Recurrence of pre‐eclampsia and the risk of future hypertension and cardiovascular disease: a systematic review and meta‐analysis
Open accessAbstract
Background: Women with a history of hypertensive disorders, including pre‐eclampsia, during pregnancy have a two‐ to‐five‐fold increased risk of cardiovascular disease (CVD). In 15% of women, pre‐eclampsia recurs in the following pregnancy. Objectives: To evaluate all evidence on the future risk of developing hypertension and CVD after multiple pregnancies complicated by pre‐eclampsia compared with pre‐eclampsia in a single pregnancy followed by normal subsequent pregnancy. Search strategy: Embase and Medline were searched until June 2017. Selection criteria: All relevant studies on the risk of developing hypertension, atherosclerosis, ischaemic heart disease, cerebrovascular accident (CVA), thromboembolism, heart failure or overall hospitalisation and mortality due to CVD after having had recurrent pre‐eclampsia. Data collection and analysis: Twenty‐two studies were included in the review. When possible, we calculated pooled risk ratios (RR) with 95% CI through random‐effect analysis. Main results: Recurrent pre‐eclampsia was consistently associated with an increased pooled risk ratio of hypertension (RR 2.3; 95% CI 1.9–2.9), ischaemic heart disease (RR 2.4; 95% CI 2.2–2.7), heart failure (RR 2.9; 95% CI 2.3–3.7), CVA (RR 1.7; 95% CI 1.2–2.6) and hospitalisation due to CVD (RR 1.6; 95% CI 1.3–1.9) when compared with women with subsequent uncomplicated pregnancies. Other studies on thromboembolism, atherosclerosis and cardiovascular mortality found a positive effect, but data could not be pooled. Conclusions: This systematic review and meta‐analysis support consistent higher risk for future development of hypertension and CVD in women with recurring pre‐eclampsia as opposed to women with a single episode of pre‐eclampsia. Tweetable abstract: The risk of future cardiovascular disease increases when women have recurrence of pre‐eclampsia compared with a single episode.
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In comparison with an episode of pre-eclampsia followed by a healthy pregnancy, a history of recurrent pre-eclampsia is associated with an increased risk of cerebrovascular accident.
“In comparison with an episode of pre-eclampsia followed by a healthy pregnancy, a history of recurrent pre-eclampsia was associated with an increased risk of composite cardiovascular disease, coronary heart disease, heart failure, and cerebrovascular accident.99”
From Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review (2020) · cites this paper as [99]
In comparison with an episode of pre-eclampsia followed by a healthy pregnancy, a history of recurrent pre-eclampsia is associated with an increased risk of composite cardiovascular disease.
“In comparison with an episode of pre-eclampsia followed by a healthy pregnancy, a history of recurrent pre-eclampsia was associated with an increased risk of composite cardiovascular disease, coronary heart disease, heart failure, and cerebrovascular accident.99”
From Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review (2020) · cites this paper as [99]
In comparison with an episode of pre-eclampsia followed by a healthy pregnancy, a history of recurrent pre-eclampsia is associated with an increased risk of coronary heart disease.
“In comparison with an episode of pre-eclampsia followed by a healthy pregnancy, a history of recurrent pre-eclampsia was associated with an increased risk of composite cardiovascular disease, coronary heart disease, heart failure, and cerebrovascular accident.99”
From Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review (2020) · cites this paper as [99]
In comparison with an episode of pre-eclampsia followed by a healthy pregnancy, a history of recurrent pre-eclampsia is associated with an increased risk of heart failure.
“In comparison with an episode of pre-eclampsia followed by a healthy pregnancy, a history of recurrent pre-eclampsia was associated with an increased risk of composite cardiovascular disease, coronary heart disease, heart failure, and cerebrovascular accident.99”
From Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review (2020) · cites this paper as [99]
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- Authors
- Brouwers, L., van der Meiden‐van Roest, A., Savelkoul, C., Vogelvang, T., Lely, A., Franx, A., & van Rijn, B.
- Affiliations
- Utrecht University (NL)
- Department of Obstetrics Wilhelmina Children's Hospital Birth Centre University Medical Centre Utrecht Utrecht University Utrecht the Netherlands
- Diakonessenhuis hospital (NL)
- Corresponding author
- Brouwers, L
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2018-08-10
- Volume
- 125
- Issue
- 13
- Pages
- 1642-1654
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- PMC
- PMC6283049
- OpenAlex
- W2880055605
- Cited by
- 247
- References
- 55
- Citations by year
- 2026: 26 · 2025: 29 · 2024: 44 · 2023: 46 · 2022: 21 · 2021: 29 · 2020: 33 · 2019: 15 · 2018: 3
- FWCI
- 3.25
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Psychiatry and Mental health › Neurological Complications and Syndromes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- preeclampsia, cardiovascular disease, hypertension, ischemic heart disease, heart failure, stroke, thromboembolism, atherosclerosis, cardiovascular hospitalization, cardiovascular mortality, hypertensive disorders of pregnancy, subsequent pregnancy
- MeSH terms
- Cardiovascular Diseases, Female, Heart Failure, Hospitalization, Humans, Hypertension, Pre-Eclampsia, Pregnancy, Recurrence, Risk Factors, Myocardial Ischemia
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