Incidence of postpartum hypertension within 2 years of a pregnancy complicated by pre-eclampsia: a systematic review and meta-analysis


Giorgione V., Ridder A., Kalafat E., Khalil A., Thilaganathan B.

BJOG: An International Journal of Obstetrics and Gynaecology, vol.128, no.3, pp.495-503, 2021 (Peer-Reviewed Journal) identifier identifier identifier

  • Publication Type: Article / Review
  • Volume: 128 Issue: 3
  • Publication Date: 2021
  • Doi Number: 10.1111/1471-0528.16545
  • Journal Name: BJOG: An International Journal of Obstetrics and Gynaecology
  • Journal Indexes: Science Citation Index Expanded, Scopus, Academic Search Premier, CAB Abstracts, CINAHL, EMBASE, MEDLINE, Public Affairs Index
  • Page Numbers: pp.495-503
  • Keywords: Cardiovascular disease prevention, hypertension, meta-analysis, pre-eclampsia, pregnancy and postpartum, CARDIOVASCULAR-DISEASE RISK, WOMEN, HISTORY, PREVENTION, GUIDELINES, DISORDERS, MORBIDITY

Abstract

© 2020 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons LtdBackground: Women with a history of hypertensive disorders of pregnancy (HDP) are at increased long-term risk of cardiovascular disease. However, there has been increasing evidence on the same risks in the months following birth. Objectives: This review aims to estimate the incidence of hypertension in the first 2 years after HDP. Search strategy: MEDLINE, Embase and Cochrane databases were systematically searched in October 2019. Selection criteria: Observational studies comparing hypertension rate following HDP and normotensive pregnancies up to 2 years. Data collection and analysis: A meta-analysis to calculate the odds ratio (OR) with a 95% confidence interval (CI) and a sub-group analysis excluding women with chronic hypertension were performed. Main results: Hypertension was diagnosed within the first 2 years following pregnancy in 468/1646 (28.4%) and 584/6395 (9.1%) of the HDP and control groups, respectively (OR 6.28; 95% CI 4.18–9.43; I2 = 56%). The risk of hypertension in HDP group was significantly higher in the first 6 months following delivery (OR 18.33; 95% CI 1.35–249.48; I2 = 84%) than at 6–12 months (OR 4.36; 95% CI 2.81–6.76; I2 = 56%) or between 1–2 years postpartum (OR 7.24; 95% CI 4.44–11.80; I2 = 9%). A sub-group analysis demonstrated a similar increase in the risk of developing postpartum hypertension after HDP (OR 5.75; 95% CI 3.92–8.44; I2 = 49%) and pre-eclampsia (OR 6.83; 95% CI 4.25–10.96; I2 = 53%). Conclusions: The augmented risk of hypertension after HDP is highest in the early postpartum period, suggesting that diagnosis and targeted interventions to improve maternal cardiovascular health may need to be commenced in the immediate postpartum period. Tweetable abstract: The risk of hypertension within 2 years of birth is six-fold higher in women who experienced pre-eclampsia.