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Pre‐eclampsia and long‐term health outcomes for mother and infant: an umbrella review
Author(s) -
Pittara T,
Vyrides A,
Lamnisos D,
Giannakou K
Publication year - 2021
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.16683
Subject(s) - medicine , eclampsia , cohort study , meta analysis , disease , confidence interval , cohort , relative risk , pregnancy , genetics , biology
Background Pre‐eclampsia is a pregnancy‐associated condition with complex disease mechanisms and a risk factor for various long‐term health outcomes for the mother and infant. Objective To summarise evidence on the association of pre‐eclampsia with long‐term health outcomes arising in women and/or infants. Search strategy PubMed, EMBASE, Scopus and ISI Web of Science were searched from inception to July 2020. Selection criteria Systematic reviews and meta‐analyses examining associations between pre‐eclampsia and long‐term health outcomes in women and their infants. Data collection and analysis Data were extracted by two independent reviewers. We re‐estimated the summary effect size by random‐effects and fixed‐effects models, the 95% confidence interval, the 95% prediction interval, the between‐study heterogeneity, any evidence of small‐study effects and excess significance bias. Results Twenty‐one articles were included (90 associations). Seventy‐nine associations had nominally statistically significant findings ( P < 0.05). Sixty‐five associations had large or very large heterogeneity. Evidence for small‐study effects and excess significance bias was found in seven and two associations, respectively. Nine associations: cerebrovascular disease (cohort studies), cerebrovascular disease (overall), cardiac disease (cohort studies), dyslipidaemia (all studies), risk of death (late‐onset pre‐eclampsia), fatal and non‐fatal ischaemic heart disease, cardiovascular mortality (cohort studies), any diabetes or use of diabetic medication (unadjusted), and attention deficit/hyperactivity disorder (ADHD) (adjusted) were supported with robust evidence. Conclusion Many of the meta‐analyses in this research field have caveats casting doubts on their validity. Current evidence suggests an increased risk for women to develop cardiovascular‐related diseases, diabetes and dyslipidaemia after pre‐eclampsia, while offspring exposed to pre‐eclampsia are at higher risk for ADHD. Tweetable abstract Cardiovascular and cerebrovascular diseases were supported with convincing evidence for long‐term health outcomes after pre‐eclampsia.