Markers of Vascular Dysfunction After Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis

Women with prior hypertensive disorders of pregnancy (HDP) are at twice the risk of cardiovascular disease compared with women with prior normotensive pregnancy, possibly because of sustained vascular dysfunction after delivery. The aim of this systematic review and meta-analysis is to summarize evidence of vascular dysfunction at least 3 months after HDP. Articles in all languages were retrieved from principal databases. Studies included were observational, with HDP as the main exposure and measurements of vascular dysfunction via imaging modalities or serum biomarkers as the main outcome, assessed at least 3 months postpartum. We pooled results of modalities reported in >3 studies using a random effects model. Of 6109 potentially relevant studies, 72 were included that evaluated 10 imaging modalities and 11 serum biomarkers in 8702 women. There was evidence of vascular dysfunction in women post HDP compared with women with prior normal pregnancy when measured by carotid-femoral pulse wave velocity (0.64 m/s [0.17-1.11]), carotid intima-media thickness (0.025 mm [0.004-0.045]), and augmentation index (5.48% [1.58-9.37]), as well as mean levels of soluble fms-like tyrosine kinase (6.12 pg/mL [1.91-10.33]). Between-groups differences in measures of vascular dysfunction were more pronounced when assessments were performed in younger women (<40 years) or closer to the index pregnancy for almost all modalities. In conclusion, pooled data from studies evaluating vascular imaging suggest that some vascular dysfunction persists after HDP as compared with women with prior normal pregnancy.