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Biochemical Cardiovascular Risk Factors After Hypertensive Pregnancy Disorders: A Systematic Review and Meta-analysis

Hermes, Wietske MD*; Ket, Johannes C.F.; van Pampus, Maria G. MD, PhD; Franx, Arie MD, PhD§; Veenendaal, Marjolein V.E. MD; Kolster, Clara; Tamsma, Jouke T. MD, PhD#; Bloemenkamp, Kitty W. M. MD, PhD**; Ponjee, Gabrielle MD, PhD††; van der Hout, Evelien MD‡‡; ten Horn, Hilde MD‡‡; Loix, Stéphanie MD§§; Mol, Ben Willem MD, PhD∥∥; de Groot, Christianne J.M. MD, PhD¶¶

Obstetrical & Gynecological Survey: December 2012 - Volume 67 - Issue 12 - p 792–808
doi: 10.1097/OGX.0b013e31827682fc
CME REVIEW ARTICLE
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The objective of this study was to perform a systematic review and meta-analysis of studies assessing biochemical cardiovascular risk factors in women with previous hypertensive pregnancy disorders and women with previous normotensive pregnancies.

Data were collected from PubMed and EMBASE (from inception to February 28, 2011) supplemented by manual searches of bibliographies.

Included were cohort studies and case-control studies assessing biochemical cardiovascular risk factors in women with previous hypertensive pregnancy disorders compared with women with previous normotensive pregnancies. Of 2573 studies reviewed for eligibility, quality, and data extraction, 22 were included in the review, of which 15 could be meta-analyzed.

The pooled mean differences for the outcomes of interest were 0.17 mmol/L (95% confidence interval [CI], 0.08–0.25 mmol/L) for glucose (10 studies), 3.46 mU/mL (95% CI, 2.34–4.58 mU/mL) for insulin (5 studies), 0.13 mmol/L (95% CI, 0.05–0.21) for triglycerides (10 studies), 0.22 mmol/L (95% CI, 0.11–0.33 mmol/L) for total cholesterol (11 studies), −0.11 mmol/L (95% CI, −0.18 to −0.04 mmol/L) for high-density lipoprotein cholesterol (10 studies), and 0.21 mmol/L (95% CI, 0.10–0.32) for low-density lipoprotein cholesterol (9 studies), all in the disadvantage in women with previous hypertensive pregnancy disorders. Analyses for preeclampsia alone showed similar results. Continued

Learning Objectives After completing this CME activity, physicians should be better able to assess the long-term cardiovascular consequences after hypertensive pregnancy disorders, evaluate and interpret the evidence regarding biochemical cardiovascular risk factor assessment after pregnancy, and counsel women with a history of hypertensive pregnancy disorders as to the effectiveness of cardiovascular risk factor assessment in the primary prevention of cardiovascular disease.

Conclusions Women with previous hypertensive pregnancy disorders have higher glucose, insulin, triglycerides, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol levels measured after pregnancy compared with women with previous normotensive pregnancies. These biochemical cardiovascular risk factors may identify women who will benefit from primary prevention of cardiovascular disease.

Target Audience Obstetricians and gynecologists, family physicians.

*Resident, Department of Obstetrics and Gynecology, Medical Center Haaglanden, the Hague, and Vu University Medical Center; †Information Specialist, Medical Library, Vu University Medical Center, Amsterdam; ‡Obstetrician, Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen; §Professor, Division Woman and Baby, University Medical Center Utrecht, Utrecht; ∥Resident, Department of Epidemiology Amsterdam Medical Center, Amsterdam ¶Research Nurse, Department of Obstetrics and Gynecology, Leiden University Medical Center; #Internist, Department of Internal Medicine University Medical Center; **Obstetrician, Department of Obstetrics, Leiden University Medical Center, Leiden; ††Clinical chemist, Department of Clinical Laboratory, Medical Center Haaglanden, the Hague; ‡‡Resident, Department of Obstetrics and Gynecology, Amsterdam Medical Center, Amsterdam; §§Resident, Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven; ∥∥Professor, Department of Obstetrics and Gynecology, Amsterdam Medical Center; and ¶¶Professor, Department of Obstetrics, Vu University Medical Center, Amsterdam

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

W.H. is currently supported by a noncommercial grant from the Landsteiner Institute, Medical Center Haaglanden, The Hague,The Netherlands and by the Nuts Ohra Foundation, The Netherlands.

Correspondence requests to: Wietske Hermes, MD, Department of Obstetrics and Gynecology, Medical Center Haaglanden, Lijnbaan 32, 2512 VA, The Hague, The Netherlands. E-mail: herwie@mchaaglanden.nl.

© 2012 Lippincott Williams & Wilkins, Inc.