Hypertensive disorders of pregnancy and adult offspring cardiometabolic outcomes: a systematic review of the literature and 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.