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Hypertensive disorders of pregnancy and adult offspring cardiometabolic outcomes: a systematic review of the literature and meta-analysis
  1. Janine Claire Thoulass1,
  2. Lynn Robertson1,
  3. Lucas Denadai2,
  4. Corri Black1,
  5. Michael Crilly1,
  6. Lisa Iversen3,
  7. Neil W Scott4,
  8. Philip Christopher Hannaford3
  1. 1Chronic Disease Research Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
  2. 2Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
  3. 3Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
  4. 4Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Dr Janine Claire Thoulass, Chronic Disease Research Group, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK; j9ct{at}yahoo.co.uk

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Background

Hypertensive disorders of pregnancy include eclampsia, pre-eclampsia, gestational hypertension, pre-existing chronic hypertension and pre-eclampsia superimposed on chronic hypertension.1 ,2 They affect up to 8% of pregnancies and are a major cause of maternal and fetal morbidity and mortality.1 Chronic hypertension is associated with a much higher risk of pre-eclampsia and, in a subset of women, worsening of hypertension during pregnancy (without development of pre-eclampsia).3 ,4

Women with pre-eclampsia have an adverse cardiovascular risk profile in later life.5 ,6 Cardiovascular risk factors in the childhood and early adulthood of offspring of pregnancies affected by pre-eclampsia have been examined in two earlier systematic reviews. These found evidence of raised blood pressure (BP) and body mass index (BMI) in the offspring born to pre-eclamptic pregnancies.7 ,8 Less is known about the later life cardiovascular risk in offspring affected by maternal pre-eclampsia or other maternal hypertensive disorders of pregnancy, although some studies suggest a higher risk of cardiovascular disease, including hypertension9 and stroke10 in adulthood.

The associations between hypertensive disorders of pregnancy and subsequent cardiovascular disease in the offspring are complex. Hypertensive disorders of pregnancy are associated with prematurity (which may be iatrogenic) and low birth weight even when corrected for gestation.11 Small for gestational age and gestation have been inversely associated with risk of cardiovascular disease.12 ,13 Furthermore, the strength of these associations varies by hypertensive disorder and severity of condition.

We have systematically reviewed published papers of the association between maternal hypertensive disorders of pregnancy, and cardiovascular risk factors and disease in adult offspring.

Methods

A systematic review of the published literature was undertaken. Inclusion criteria were:

Types of study

Observational epidemiological studies of offspring exposed in utero to a maternal hypertensive disorder of pregnancy.

Types of participant

Offspring aged at least 18 years at last …

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