There is increasing evidence that pre-eclampsia, a principal cause of maternal morbidity, may also be a risk factor for future cardiovascular and cerebrovascular events. This review aimed to assess the current evidence and quantify the risks of cardiovascular disease (CVD), cerebrovascular events and hypertension associated with prior diagnosis of pre-eclampsia. Medline and Embase were searched with no language restrictions, as were core journals and reference lists from reviews up until January 2012. Case–control and cohort studies which reported cardiovascular and cerebrovascular diseases or hypertension diagnosed more than 6 weeks postpartum, in women who had a history of pre-eclampsia relative to women who had unaffected pregnancies, were included. Fifty articles were included in the systematic review and 43 in the meta-analysis. Women with a history of pre-eclampsia or eclampsia were at significantly increased odds of fatal or diagnosed CVD [odds ratio (OR) = 2.28, 95 % confidence interval (CI): 1.87, 2.78], cerebrovascular disease (OR = 1.76, 95 % CI 1.43, 2.21) and hypertension [relative risk (RR) = 3.13, 95 % CI 2.51, 3.89]. Among pre-eclamptic women, pre-term delivery was not associated with an increased risk of a future cardiovascular event (RR = 1.32, 95 % CI 0.79, 2.22). Women diagnosed with pre-eclampsia are at increased risk of future cardiovascular or cerebrovascular events, with an estimated doubling of odds compared to unaffected women. This has implications for the follow-up of all women who experience pre-eclampsia, not just those who deliver pre-term. This association may reflect shared common risk factors for both pre-eclampsia and cardiovascular and cerebrovascular disease.
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Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol. 2009;33:130–7.
Bellamy L, Casas J-P, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ. 2007;335:974.
McDonald SD, Malinowski A, Zhou Q, Yusuf S, Devereaux PJ. Cardiovascular sequelae of preeclampsia/eclampsia: a systematic review and meta-analyses. Am Heart J. 2008;156:918–30.
World Health Organization. Women’s health. 2009. http://www.who.int/mediacentre/factsheets/fs334/en/index.html. Accessed 03 Jul 2011.
Magee L, Newstead J, Ng J, Ct A, Von Dadelszen P. Pre-eclampsia as a marker of cardiovascular disease. Fetal Matern Med Rev. 2008;19:271–92.
Berends AL, de Groot CJM, Sijbrands EJ, Sie MPS, Benneheij SH, Pal R, Heydanus R, Oostra BA, van Duijn CM, Steegers EAP. Shared constitutional risks for maternal vascular-related pregnancy complications and future cardiovascular disease. Hypertension. 2008;51:1034–41.
Magnussen EB, Vatten LJ, Lund-Nilsen TI, Salvesen KA, Davey Smith G, Romundstad PR. Prepregnancy cardiovascular risk factors as predictors of pre-eclampsia: population based cohort study. BMJ. 2007;335:978.
Rodie VA, Freeman DJ, Sattar N, Greer IA. Pre-eclampsia and cardiovascular disease: metabolic syndrome of pregnancy? Atherosclerosis. 2004;175:189–202.
Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM. The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertens Pregnancy. 2001;20:IX–XIV.
Garovic VD, Hayman SR. Hypertension in pregnancy: an emerging risk factor for cardiovascular disease. Nat Clin Pract Nephrol. 2007;3:613–22.
Craici I, Wagner S, Garovic VD. Preeclampsia and future cardiovascular risk: formal risk factor or failed stress test? Ther Adv Cardiovasc Dis. 2008;2:249–59.
National Institute for Health and Clinical Excellence. Hypertension in pregnancy the management of hypertensive disorders during pregnancy, vol. CG107. London: Royal College of Obstetricians and Gynaecologists; 2010.
Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, Newby LK, Piña IL, Roger VRL, Shaw LJ, Zhao D, Beckie TM, Bushnell C, D’Armiento J, Kris-Etherton PM, Fang J, Ganiats TG, Gomes AS, Gracia CR, Haan CK, Jackson EA, Judelson DR, Kelepouris E, Lavie CJ, Moore A, Nussmeier NA, Ofili E, Oparil S, Ouyang P, Pinn VW, Sherif K, Smith SC, Sopko G, Chandra-Strobos N, Urbina EM, Vaccarino V, Wenger NK. Effectiveness-based guidelines for the prevention of cardiovascular disease in women—2011 update: a guideline from the American Heart Association. Circulation. 2011;123:1243–62.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB. Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA. 2000;283:2008.
Egger M, Smith GD, Altman DG. Systematic reviews in health care: meta-analysis in context. London: BMJ Books; 2001.
Higgins J, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557.
Ray J, Vermeulen MJ, Schull MJ, Redelmeier DA. Cardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study. Lancet. 2005;366:1797–803.
Jónsdóttir LS, Arngrimsson R, Geirsson RT, Slgvaldason H, Slgfússon N. Death rates from ischemic heart disease in women with a history of hypertension in pregnancy. Acta Obstet Gynecol Scand. 1995;74:772–6.
Berends AL, Zillikens MC, De Groot CJM, Rivadeneira F, Oostra BA, Van Duijn CM, Steegers EAP. Body composition by dual-energy X-ray absorptiometry in women with previous pre-eclampsia or small-for-gestational-age offspring. BJOG. 2009;116:442–50.
Portelinha A, Belo L, Cerdeira AS, Braga J, Tejera E, Pinto F, Pinto A, Areias MJ, Patricio B, Rebelo I. Lipid levels including oxidized LDL in women with history of preeclampsia. Hypertens Pregnancy. 2010;29:93–100.
Hubel CA, Powers RW, Snaedal S, Gammill HS, Ness RB, Roberts JM, Arngrimsson R. C-reactive protein is elevated 30 years after eclamptic pregnancy. Hypertension. 2008;51:1499–505.
Souwer ETD, Blaauw J, Coffeng SM, Smit AJ, Van Doormaal JJ, Faas MM, Van Pampus MG. Decreased arterial elasticity in formerly early-onset preeclamptic women. Acta Obstet Gynecol Scand. 2011;90:797–801.
Lin YS, Tang CH, Yang CYC, Wu LS, Hung ST, Hwa HL, Chu PH. Effect of pre-eclampsia-eclampsia on major cardiovascular events among peripartum women in Taiwan. Am J Cardiol. 2011;107:325–30.
Croft P, Hannaford PC. Risk factors for acute myocardial infarction in women: evidence from the Royal College of General Practitioners’ oral contraception study. BMJ. 1989;298:165–8.
Hannaford P, Ferry S, Hirsch S. Cardiovascular sequelae of toxaemia of pregnancy. Heart. 1997;77:154–8.
Lykke JA, Langhoff-Roos J, Sibai BM, Funai EF, Triche EW, Paidas MJ. Hypertensive pregnancy disorders and subsequent cardiovascular morbidity and type 2 diabetes mellitus in the mother. Hypertension. 2009;53:944–51.
Lykke JA, Langhoff-Roos J, Lockwood CJ, Triche EW, Paidas MJ. Mortality of mothers from cardiovascular and non-cardiovascular causes following pregnancy complications in first delivery. Paediatr Perinat Epidemiol. 2010;24:323–30.
Kestenbaum B, Seliger SL, Easterling TR, Gillen DL, Critchlow CW, Stehman-Breen CO, Schwartz SM. Cardiovascular and thromboembolic events following hypertensive pregnancy. Am J Kidney Dis. 2003;42:982–9.
Iversen L, Hannaford PC. Toxaemia of pregnancy and risk of mortality in later life: evidence from the royal college of general practitioners’ oral contraception study. Hypertens Pregnancy. 2010;29:180–97.
Soonthornpun K, Soonthornpun S, Wannaro P, Setasuban W, Thamprasit A. Insulin resistance in women with a history of severe pre-eclampsia. J Obstet Gynaecol Res. 2009;35:55–9.
Garovic VD, Bailey KR, Boerwinkle E, Hunt SC, Weder AB, Curb D, Mosley TH Jr, Wiste HJ, Turner ST. Hypertension in pregnancy as a risk factor for cardiovascular disease later in life. J Hypertens. 2010;28:826–33.
Tang CH, Wu CS, Lee TH, Hung ST, Yang CYC, Lee CH, Chu PH. Preeclampsia–eclampsia and the risk of stroke among peripartum in Taiwan. Stroke. 2009;40:1162–8.
Saldarriaga CI, Franco G, Garzon AM, Garcia I, Mejia N, Restrepo A. Factores de riesgo para la enfermedad coronaria temprana en mujeres [Risk factors for premature coronary disease in women]. Biomedica. 2010;30:559–66.
Wilson BJ, Watson MS, Prescott GJ, Sunderland S, Campbell DM, Hannaford P, Smith WCS. Hypertensive diseases of pregnancy and risk of hypertension and stroke in later life: results from cohort study. BMJ. 2003;326:845.
Freibert SM, Mannino DM, Bush H, Crofford LJ. The association of adverse pregnancy events and cardiovascular disease in women 50 years of age and older. J Womens Health (Larchmt). 2011;20:287–93.
Mann JI, Doll R, Thorogood M, Vessey MP, Waters WE. Risk factors for myocardial infarction in young women. Br J Prev Soc Med. 1976;30:94–100.
Rosenberg L, Miller DR, Kaufman DW, Helmrich SP, Van de Carr S, Stolley PD, Shapiro S. Myocardial infarction in women under 50 years of age. JAMA. 1983;250:2801–6.
Haukkamaa L, Salminen M, Laivuori H, Leinonen H, Hiilesmaa V, Kaaja R. Risk for subsequent coronary artery disease after preeclampsia. Am J Cardiol. 2004;93:805–8.
Haukkamaa L, Moilanen L, Kattainen A, Luoto R, Kahonen M, Leinonen M, Jula A, Kesaniemi YA, Kaaja R. Pre-eclampsia is a risk factor of carotid artery atherosclerosis. Cerebrovasc Dis. 2009;27:599–607.
Kaaja R, Kinnunen T, Luoto R. Regional differences in the prevalence of pre-eclampsia in relation to the risk factors for coronary artery disease in women in Finland. Eur Heart J. 2005;26:44–50.
Smith GCS, Pell JP, Walsh D. Pregnancy complications and maternal risk of ischaemic heart disease: a retrospective cohort study of 129,290 births. Lancet. 2001;357:2002–6.
Wikström A-K, Haglund B, Olovsson M, Lindeberg SN. The risk of maternal ischaemic heart disease after gestational hypertensive disease. BJOG. 2005;112:1486–91.
Funai EF, Friedlander Y, Paltiel O, Tiram E, Xue X, Deutsch L, Harlap S. Long-term mortality after preeclampsia. Epidemiology. 2005;16:206–15.
Irgens HU, Reisaeter L, Irgens LM, Lie RT, Roberts JM. Long term mortality of mothers and fathers after pre-eclampsia: population based cohort study/pre-eclampsia and cardiovascular disease later in life: who is at risk? BMJ. 2001;323:1213–7.
Mongraw-Chaffin ML, Cirillo PM, Cohn BA. Preeclampsia and cardiovascular disease death: prospective evidence from the child health and development studies cohort. Hypertension. 2010;56:166–71.
Brown DW, Dueker N, Jamieson DJ, Cole JW, Wozniak MA, Stern BJ, Giles WH, Kittner SJ. Preeclampsia and the risk of ischemic stroke among young women: results from the stroke prevention in young women study. Stroke. 2006;37:1055–9.
Ben-Ami S, Oron G, Ben-Haroush A, Blickstein D, Hod M, Bar J. Primary atherothrombotic occlusive vascular events in premenopausal women with history of adverse pregnancy outcome. Thromb Res. 2010;125:124–7.
Thorogood M, Mann J, Murphy M, Vessey M. Fatal stroke and use of oral contraceptives: findings from a case–control study. Am J Epidemiol. 1992;136:35–45.
Adams E, MacGillivray I. Long-term effect of pre-eclampsia on blood-pressure. Lancet. 1961;278:1373–5.
Epstein FH. Late vascular effects of toxemia of pregnancy. N Engl J Med. 1964;271:391–5.
Carleton H, Forsythe A, Flores R. Remote prognosis of preeclampsia in women 25 years old and younger. Am J Obstet Gynecol. 1988;159:156–60.
Nisell H, Lintu H, Lunell NO, Möllerström G, Pettersson E. Blood pressure and renal function seven years after pregnancy complicated by hypertension. BJOG. 1995;102:876–81.
North RA, Simmons D, Bamfather D, Upjohn M. What happens to women with preeclampsia? Microalbuminuria and hypertension following preeclampsia. Aust N Z J Obstet Gynaecol. 1996;36:233–8.
Laivuori H, Tikkanen MJ, Ylikorkala O. Hyperinsulinemia 17 years after preeclamptic first pregnancy. J Clin Endocrinol Metab. 1996;81:2908–11.
Marin R, Gorostidi M, Portal CG, Sanchez M, Sanchez E, Alvarez J. Long-term prognosis of hypertension in pregnancy. Hypertens Pregnancy. 2000;19:199–209.
Shammas AM, Maayah JF. JF. Hypertension and its relation to renal function 10 years after pregnancy complicated by pre-eclampsia and pregnancy induced hypertension. Saudi Med J. 2000;21:190–2.
Blaauw J, van Pampus MG, Van Doormaal JJ, Fokkema MR, Fidler V, Smit AJ, Aarnoudse JG. Increased intima–media thickness after early-onset preeclampsia. Obstet Gynecol. 2006;107:1345–51.
Canti IC, Komlos M, Martins-Costa SH, Geraldo Lopes Ramos J, Capp E, Corleta HE. Risk factors for cardiovascular disease ten years after preeclampsia [Fatores de risco para doenca cardiovascular dez anos apos pre-eclampsia]. Sao Paulo Med J. 2010;128:10–3.
Kharazmi E, Kaaja R, Fallah M, Luoto R. Pregnancy-related factors and the risk of isolated systolic hypertension. Blood Press. 2007;16:50–5.
Spaan JJ, Ekhart T, Spaanderman MEA, Peeters LLH. Remote hemodynamics and renal function in formerly preeclamptic women. Obstet Gynecol. 2009;113:853–9.
Gaugler-Senden IPM, Berends AL, de Groot CJM, Steegers EAP. Severe, very early onset preeclampsia: subsequent pregnancies and future parental cardiovascular health. Eur J Obstet Gynecol Reprod Biol. 2008;140:171–7.
Aukes AM, de Groot JC, Aarnoudse JG, Zeeman GG. Brain lesions several years after eclampsia. Am J Obstet Gynecol. 2009;200:504.e1–5.
Shahbazian N, Shahbazian H, Ehsanpour A, Aref A, Gharibzadeh S. Hypertension and microalbuminuria 5 years after pregnancies complicated by pre-eclampsia. Iran J Kidney Dis. 2011;5:324–7.
Melchiorre K, Sutherland GR, Liberati M, Thilaganathan B. Preeclampsia is associated with persistent postpartum cardiovascular impairment. Hypertension. 2011;58:709–15.
Manten GTR, Sikkema MJ, Voorbij HAM, Visser GHA, Bruinse HW, Franx A. Risk factors for cardiovascular disease in women with a history of pregnancy complicated by preeclampsia or intrauterine growth restriction. Hypertens Pregnancy. 2007;26:39–50.
Sibai B, el Nazer A, Gonzalez-Ruiz A. Severe preeclampsia-eclampsia in young primigravid women: subsequent pregnancy outcome and remote prognosis. Am J Obstet Gynecol. 1986;155:1011.
Royal College of Obstetricians and Gynaecologists. Pre-eclampsia-study group consensus statement. 2003. http://www.rcog.org.uk/womens-health/clinical-guidance/pre-eclampsia-study-group-consensus-statement. Accessed 25 Sep 2011.
Brown M, Haugue WM, Higgins J, Lowe S, McCowan L, Oats J, Peek MJ, Rowan JA, Walthers BNJ. The detection, investigation, and management of hypertension in pregnancy: executive summary. Aust N Z J Obstet Gynacol. 2000;40:133–8.
Diehl CL, Brost BC, Hogan MC, Elesber AA, Offord KP, Turner ST, Garovic VD. Preeclampsia as a risk factor for cardiovascular disease later in life: validation of a preeclampsia questionnaire. Am J Obstet Gynecol. 2008;198:e11–3.
Coolman M, de Groot CJM, Jaddoe VW, Hofman A, Raat H, Steegers EAP. Medical record validation of maternally reported history of preeclampsia. J Clin Epidemiol. 2010;63:932–7.
Malik AS, Giamouzis G, Georgiopoulou VV, Fike LV, Kalogeropoulos AP, Norton CR, Sorescu D, Azim S, Laskar SR, Smith AL, Dunbar SB, Butler J. Patient perception versus medical record entry of health-related conditions among patients with heart failure. Am J Cardiol. 2010;107:569–72.
Okura Y, Urban LH, Mahoney DW, Jacobsen SJ, Rodeheffer RJ. Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure. J Clin Epidemiol. 2004;57:1096–103.
Geller SE, Ahmed S, Brown ML, Cox SM, Rosenberg D, Kilpatrick SJ. International classification of diseases-9th revision coding for preeclampsia: how accurate is it? Am J Obstet Gynecol. 2004;190:1629–33.
Roberts CL, Bell JC, Ford JB, Hadfield RM, Algert CS, Morris JM. The accuracy of reporting of the hypertensive disorders of pregnancy in population health data. Hypertens Pregnancy. 2008;27:285–97.
Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet. 2010;376:631–44.
Von Dadelszen P, Magee L, Roberts JM. Sub-classification of preeclampsia. Hypertens Pregnancy. 2003;22:143–8.
Koopmans CM, Bijlenga D, Groen H, Vijgen SM, Aarnoudse JG, Bekedam DJ, et al. Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks’ gestation (HYPITAT): a multicentre, open-label randomised controlled trial. Lancet. 2009;374:979–88.
Srinivas SK, Sammel MD, Bastek J, Ofori E, Andrela CM, Wolfe ML, Reilly M, Elovitz MA. Evaluating the association between all components of the metabolic syndrome and pre-eclampsia. J Matern Fetal Neonatal Med. 2009;22:501–9.
Callaway LK, Lawlor DA, O’Callaghan M, Williams GM, Najman JM, McIntyre HD. Diabetes mellitus in the 21 years after a pregnancy that was complicated by hypertension: findings from a prospective cohort study. Am J Obstet Gynecol. 2007;197:492.e1–7.
Carr DB, Newton KM, Utzschneider KM, Tong J, Gerchman F, Kahn SE, Easterling TR, Heckbert SR. Preeclampsia and risk of developing subsequent diabetes. Hypertens Pregnancy. 2009;28:435–47.
Libby G, Murphy DJ, McEwan NF, Greene SA, Forsyth JS, Chien PW, Morris AD, for the DMC. Pre-eclampsia and the later development of type 2 diabetes in mothers and their children: an intergenerational study from the Walker cohort. Diabetologia. 2007;50:523–30.
British Heart Foundation. Coronary heart disease statistics. 2010. http://www.bhf.org.uk/research/statistics.aspx. Accessed 8 Jan 2012.
Smith GN, Walker MC, Liu A, Wen SW, Swansburg M, Ramshaw H, White RR, Roddy M, Hladunewich M. A history of preeclampsia identifies women who have underlying cardiovascular risk factors. Am J Obstet Gynecol. 2009;200:58.e1–8.
Lloyd-Jones DM, Leip EP, Larson MG, D’Agostino RB, Beiser A, Wilson PWF, Wolf PA, Levy D. Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age. Circulation. 2006;113:791–8.
Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L, Investigators IS. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case–control study. Lancet. 2004;364:937–52.
MacDonald SE, Walker M, Ramshaw H, Godwin M, Chen X-K, Smith G. Hypertensive disorders of pregnancy and long-term risk of hypertension: what do Ontario prenatal care providers know, and what do they communicate? JOGC. 2007;29:705–10.
Nijdam ME, Timmerman MR, Franx A, Bruinse HW, Numans ME, Grobbee DE, Bots ML. Cardiovascular risk factor assessment after pre-eclampsia in primary care. BMC Fam Pract. 2009;10:77.
Young B, Hacker MR, Rana S. Physicians’ knowledge of future vascular disease in women with preeclampsia. Hypertens Pregnancy. 2012;31:50–8.
Hubel CA, Snaedal S, Ness RB, Weissfeld LA, Geirsson RT, Roberts JM, Arngrímsson R. Dyslipoproteinaemia in postmenopausal women with a history of eclampsia. BJOG. 2000;107:776–84.
Sattar N, Ramsay J, Crawford L, Cheyne H, Greer IA. Classic and novel risk factor parameters in women with a history of preeclampsia. Hypertension. 2003;42:39–42.
Edlow AG, Srinivas SK, Elovitz MA. Investigating the risk of hypertension shortly after pregnancies complicated by preeclampsia. Am J Obstet Gynecol. 2009;200:e60–2.
Magnussen EB, Vatten LJ, Smith GD, Romundstad PR. Hypertensive disorders in pregnancy and subsequently measured cardiovascular risk factors. Obstet Gynecol. 2009;114:961–70.
This research is funded by Newcastle upon Tyne Hospitals NHS Foundation Trust.
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Brown, M.C., Best, K.E., Pearce, M.S. et al. Cardiovascular disease risk in women with pre-eclampsia: systematic review and meta-analysis. Eur J Epidemiol 28, 1–19 (2013). https://doi.org/10.1007/s10654-013-9762-6
- Cardiovascular disease
- Cerebrovascular disease