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- PERINATAL EPIDEMIOLOGY
- Epidemiology of cardiovascular disease
- Lifecourse / Childhood Circumstances
- META ANALYSIS
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.
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 …
MESH Terms, Prenatal Exposure Delayed Effects, Adult Children, Hypertension, Pregnancy-Induced, Cardiovascular diseases, Risk Factors.
Contributors JCT, CB, PCH and CM were involved in conception and design. JCT, LR, LD, LI, CM, CB and PCH were involved in the literature search and data abstraction, and/or quality assessment process. JCT, LR, CB, CM, LI, NWS and PCH contributed to the analysis and interpretation of the findings. JCT drafted the manuscript and all authors contributed to revisions. JCT is the guarantor.
Funding NHS Grampian Endowment Funding.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional unpublished data available (all additional materials will be made available online).