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Sydän- ja verisuonitautien riskitekijät hypertensiivisestä raskaudesta syntyneillä lapsilla ja aikuisilla / Cardiometabolic risk factors in children and adults born from a pregnancy complicated by maternal hypertension

Näytönastekatsaukset
Eero Kajantie and Jorma Komulainen
2.12.2021

Level of evidence: B

Children and adults born from a pregnancy complicated by pre-eclampsia probably have higher blood pressure and higher body mass index than others.

A systematic review and meta-analysis «Andraweera PH, Lassi ZS. Cardiovascular Risk Facto...»1 compared cardiometabolic risk factors among children and adults born from a pregnancy complicated by maternal pre-eclampsia to those among other children and adults. The meta-analysis included literature published in English by 31 August 2017. It comprised result from 15 original articles with 1 599 offspring born from a pregnancy complicated by pre-eclampsia and 51 430 controls, aged 0 to 30 years, predominantly from high-income countries. Those born from a pre-eclamptic pregnancy had 5.17 mmHg higher systolic (95 % CI 1.60-8.73) and 4.06 mmHg higher diastolic (95 % CI 0,67-7.44) blood pressure. Of the studies, 13 included information on BMI at ages 0 to 30 years (n = 1 752 + 51 541), and it was 0.36 kg/m2 higher (95 % CI 0.04-0.68). No difference was found in total cholesterol (n = 396 + 3 798, mean difference 0.47 mmol/l, 95 % CI -0.21-1.16), LDL cholesterol (n = 268 + 2 465, mean difference 0.12 mmol/l, 95 % CI -0.09-0.34), HDL cholesterol (n = 503 + 7 181, mean difference 0.05 mmol/l, 95 % CI -0.47-0.56), triglycerides (n = 215 + 1 061, mean difference 0.05 mmol/l, 95 % CI -0.13-0.23), fasting glucose (n = 486 + 3 848, mean difference 0.01 mmol/l, 95 % CI -0.03-0.06) or fasting insulin (n = 215 + 1 061, mean difference 0.25 SD units, 95 % CI -0.03-0.53).

  • Study quality: moderate
  • Applicability: good
  • Comment: The meta-analysis included two studies in newborns; for one of these studies «Howlader MZ, Parveen S, Tamanna S ym. Oxidative st...»2 of 15 pre-eclamptic participants and 20 controls, maternal blood pressure values instead of child values had been included. Severity of pre-eclampsia, gestational age or relative birth weight were not taken into account.

A systematic review «Jansen MA, Pluymen LP, Dalmeijer GW ym. Hypertensi...»3 assessed cardiometabolic risk factors in offspring aged 2 to 18 years in literature published by January 2019, predominantly from high-income countries, with separate comparisons of those born from a pregnancy complicated by pre-eclampsia with controls, and of those born from a pregnancy complicated by gestational hypertension with controls. No meta-analysis was performed. The conclusions were based on the proportions of articles with statistically significant difference in each outcome variable. As to comparisons between offspring born from pre-eclamptic and normotensive pregnancies, 3 out of 10 studies showed higher systolic and diastolic blood pressure, and of 5 studies assessed, no study showed a difference in plasma lipids. As to comparisons between offspring born from pregnancies with gestational hypertension and offspring from normotensive pregnancies, 4/5 studies reported higher systolic and 3/5 higher diastolic blood pressure.

  • Study quality: low
  • Applicability: moderate
  • Comment: It is unclear whether the lack of a statistically significant difference in an individual study is due to a true lack of difference or insufficient statistical power.

A meta-analysis «Wang LB, Qu B, Xu P ym. Preeclampsia exposed offsp...»4 included 16 studies published by March 2019, mostly from high-income countries, comparing 2 353 offspring born from a pregnancy complicated by pre-eclampsia with 68 492 controls who were not born from such pregnancy. Mean age was 15.5 years. Those born from a pre-eclamptic pregnancy had 0.54 kg/m2 higher body mass index (BMI; 95 % CI 0.27-0.82) and were more likely to be obese (odds ratio 2.12, 95 % CI 1.70-2.66). Six studies reported on waist circumference, which was on average 1.37 cm longer (95 % CI 0.67-2.06). Four studies reported sex-specific analyses for BMI. Among girls (n = 416 + 20 815), mean difference was 0.89 kg/m2 (95 % CI 0.55-1.23) and among boys (n = 277 + 10 313) 0.61 kg/m2 (95 % CI -0.13-1.35).

  • Study quality: high
  • Applicability: good
  • Comment: Severity of pre-eclampsia, gestational age or relative birth weight were not taken into account.

An individual-participant meta-analysis «Hovi P, Vohr B, Ment LR ym. Blood Pressure in Youn...»5 compared blood pressure in young adults born preterm at very low birth weight (VLBW; < 1 500 g) and controls born at term. Information on maternal pre-eclampsia (a frequent cause underlying preterm birth) was available in 7 studies, which included 928 VLBW adults, of whom 154 (16.6 %) were exposed to maternal pre-eclampsia, and a comparison group of 623 adults born at term. Compared with those born at term, those born preterm VLBW from a pre-eclamptic pregnancy had 5.8 mmHg higher systolic (95 % CI 3.6-7.9) and 4.2 mmHg higher diastolic (95 % CI 2.7-5.8) blood pressure. Correspondingly, those born preterm VLBW from a non-pre-eclamptic pregnancy had 3.8 mmHg higher systolic (95 % CI 2.4-5.1) and 2.0 mmHg higher diastolic (95 % CI 1.0-2.9) blood pressure. When SGA and pre-eclampsia were entered in simultaneous regression models within the VLBW subjects, pre-eclampsia was associated with 2.3 mm Hg (95 % CI -0.1-4.5) higher systolic and 1.8 mm Hg (95 % CI 0.5-3.1) higher diastolic blood pressure, whereas SGA status was associated with 2.7 mm Hg (95 % CI -0.4-5.7) lower systolic and 0.3 mm Hg (95 % CI -1.9-2.4) lower diastolic pressure.

  • Study quality: high
  • Applicability: good
  • Comment: Being born preterm at very low birth weight (VLBW, < 1 500g) is per se a risk factor of higher blood pressure in adult life. The paper shows that maternal pre-eclampsia is associated with higher blood pressure also among the important subgroup of those born preterm at VLBW.

References

  1. Andraweera PH, Lassi ZS. Cardiovascular Risk Factors in Offspring of Preeclamptic Pregnancies-Systematic Review and Meta-Analysis. J Pediatr 2019;208:104-13.e6 «PMID: 30876753»PubMed
  2. Howlader MZ, Parveen S, Tamanna S ym. Oxidative stress and antioxidant status in neonates born to pre-eclamptic mother. J Trop Pediatr 2009;55:363-7 «PMID: 19380372»PubMed
  3. Jansen MA, Pluymen LP, Dalmeijer GW ym. Hypertensive disorders of pregnancy and cardiometabolic outcomes in childhood: A systematic review. Eur J Prev Cardiol 2019;26:1718-47 «PMID: 31132891»PubMed
  4. Wang LB, Qu B, Xu P ym. Preeclampsia exposed offspring have greater body mass index than non-exposed offspring during peripubertal life: A meta-analysis. Pregnancy Hypertens 2020;19:247-52 «PMID: 31806501»PubMed
  5. Hovi P, Vohr B, Ment LR ym. Blood Pressure in Young Adults Born at Very Low Birth Weight: Adults Born Preterm International Collaboration. Hypertension 2016;68:880-7 «PMID: 27572149»PubMed