Table 1. Summary of studies on cardiovascular effects on offspring.
| Authors, years of publication | Study design | Study groups ( n ) | Offspring birth year/age when measured | Summary of results | Confounders adjusted for | Definition of preeclampsia |
|---|---|---|---|---|---|---|
| Nahum et al, 22 2018 | Cohort follow-up | Severe preeclampsia (2,174) Mild preeclampsia (7,286) Control (221,765) |
1991–2014 | Hypertension (%): incidence rates Severe preeclampsia: 0.14; mild preeclampsia: 0.11; control: 0.06. p < 0.001 |
Sex of the offspring, IUGR, maternal diabetes, obesity of the offspring. | |
| Boyd et al, 17 2017 | Cohort study |
Early preterm preeclampsia
a
(3,617)
Late preterm preeclampsia (5,512) Term preeclampsia (45,611) Normotensive pregnancy (1,900,142) |
1978–2010 | Congenital heart defect: OR (95% CI) Early preterm preeclampsia = 7.00, 95% CI: 6.11–8.03 Late preterm preeclampsia = 2.82, 95% CI: 2.38–3.34 Term preeclampsia = 1.16, 95% CI: 1.06–1.27. |
Maternal age, parity and delivery year. | |
| Alsnes et al, 8 2017 | Prospective cohort studies | Preterm preeclampsia (27) Term preeclampsia (343) Normotensive pregnancy (15,072) |
Mean 29 years | SBP (mm Hg): mean (95% CI) Term preeclampsia: 2.3 mm Hg (95% CI: 1.1–3.5 mm Hg) higher than normotensive pregnancy. Preterm preeclampsia: no strong evidence of differences between preterm preeclampsia and normotensive pregnancy. DBP (mm Hg): mean (95% CI) term preeclampsia: 1.0 mm Hg (95% CI: 0.1–1.9 mm Hg) higher than normotensive pregnancy. Preterm preeclampsia: no strong evidence of differences between preterm preeclampsia and normotensive pregnancy. BMI (kg/m 2 ): mean (95% CI) Term preeclampsia: 0.93 kg/m 2 (95%CI: 0.41–1.44 kg/m 2 ) higher than normotensive pregnancy. Preterm preeclampsia: no strong evidence of differences between preterm preeclampsia and normotensive pregnancy. |
Offspring age and sex, maternal parity, cardiovascular risk factors including maternal smoking, education BMI, SBP, and DBP. | Sustained increase in blood pressure, ≥ 140 mm Hg systolic and 90 mm Hg diastolic pressure, with onset after 20 weeks of gestation, with proteinuria after gestational week 20. |
| Timpka et al, 18 2016 | Prospective cohort study | Preeclampsia (42) Normotensive pregnancy |
Mean 17.7 years | Relative wall thickness: preeclampsia: 0.025 (95% CI: 0.008–0.043) greater than normotensive pregnancy. | Maternal age, offspring age, and sex, prepregnancy BMI, parity, and glycosuria/diabetes | New hypertension that manifests in previously normotensive women following the 20th week of pregnancy |
| Miliku et al, 9 2016 | Prospective cohort study | Preeclampsia (93) Normotensive pregnancy (4,888) |
Median 6.0 years | SBP (mm Hg): preeclampsia = 0.14 (95% CI: −0.01 to 0.28) higher than normotensive pregnancy. DBP (mm Hg): preeclampsia = 0.03 (95% CI: −0.09 to 0.15) higher than normotensive pregnancy. |
Maternal age, prepregnancy BMI, ethnicity, parity, educational level, smoking during pregnancy, alcohol consumption, and folic acid supplement intake, and childhood current BMI. | Development of SBP ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg after 20 weeks of gestation in previously normotensive women with the presence of proteinuria. |
| Auger et al, 19 2015 | Population based study | Preeclampsia (72,782) Early-onset preeclampsia (5,488) Late-onset preeclampsia (67,215) No preeclampsia (1,869,290) |
Congenital heart defects: overall prevalence; Preeclampsia: 1 6.7/1,000. No preeclampsia: 8.6/1,000. Critical heart defects: prevalence. Preeclampsia: 123.7/100,000, early-onset preeclampsia: 364.4/100,000, late-onset preeclampsia: 104/100,000, no preeclampsia: 75.6/100,000, noncritical heart defects: prevalence, preeclampsia: 1,538.8/100,000, early-onset preeclampsia: 7,306.9/100,000, late-onset preeclampsia: 1069.7/100,000, no preeclampsia: 789.2/100,000. |
Maternal age, parity, multiple birth, socioeconomic deprivation, and period. | Hypertension and proteinuria developing after 20 weeks of gestation in women who were previously normotensive. | |
| Brodwall et al, 20 2016 | Cohort study | Early-onset preeclampsia (2,618) Late-onset preeclampsia (30,246) Normotensive pregnancy (868,090) |
1994–2009 | Severe congenital heart defects: RR. Preeclampsia: RR = 1.3 (95% CI: 1.1–1.5), early-onset preeclampsia: RR = 2.8 (95%CI: 1.8 to 4.4) compared with normotensive pregnancy. |
Birth year, maternal age, parity, and pregestational diabetes. | SBP ≥ 140 mm Hg, DBP ≥ 90 mm Hg and proteinuria. |
| Staley et al, 10 2015 | Cohort study | Preeclampsia (161) No evidence of hypertension (6,716) |
7, 9, 10, 11, 13, 15, 17 y | SBP (mm Hg): mean difference (95% CI). Preeclampsia: 1.22 mm Hg (95% CI: −0.52 to 2.97) higher compared with no evidence of hypertension in 7 y. DBP (mm Hg): mean difference (95% CI) Preeclampsia: 0.80 mm Hg (95% CI: −0.53 to 2.13) higher compared with no evidence of hypertension in 7 y. These differences were consistent across childhood to age 18 y. |
Maternal characteristics: prepregnancy BMI, maternal age, parity, smoking during pregnancy, education, social class and offspring sex, BMI, and height. | proteinuria of at least 1 + on dipstick testing occurring at the same time as the elevated BP. |
| Fraser et al, 11 2013 | Prospective cohort study | Preeclampsia (53) Normotensive pregnancy (2,404) |
Mean 17 y | SPB (mm Hg): mean difference (95% CI).Preeclampsia: 1.12 mm Hg (95% CI: −0.89 to 3.12) higher than normotensive pregnancy. DPB (mm Hg): mean difference (95% CI). Preeclampsia: 1.71 mm Hg (95% CI: 0.23–3.17) higher than normotensive pregnancy. BMI (kg/m 2 ): preeclampsia = 4 Normotensive pregnancy: 22.3, p < 0.05 |
Offspring age, sex, maternal age at delivery, household social class, prepregnancy BMI, parity, and smoking in pregnancy. | SBP ≥ 140 mm Hg or DBP ≥90 mm Hg, measured on at least two occasions after 20 weeks of gestation, with proteinuria, diagnosed if the protein reading on dipstick testing was at least 1 + (30 mg/dL), occurring at the same time as the elevated blood pressure. |
| Miettola et al, 12 2013 | Prospective cohort study | Preeclampsia (197) Normotensive pregnancy (5,045) |
16 y | No significant differences in SBP, DBP, and MAP between offspring of preeclampsia and normotensive pregnancy. | Offspring sex, offspring BMI at age 16 y, birth weight, nulliparity, maternal prepregnancy BMI, and socioeconomic position. | BP ≥ 140/90 mm Hg and proteinuria. |
| Lawlor et al, 13 2012 | Cohort study | Preeclampsia (102) Normotensive pregnancy (3,781) |
10.7 y | SPB (mm Hg): mean difference (95% CI). Preeclampsia: 1.82 mm Hg (95% CI: 0.03–3.62) higher than normotensive pregnancy. DPB (mm Hg): mean difference (95% CI). Preeclampsia: 1.40 mm Hg (95%CI: −0.17 to 2.98) higher than normotensive pregnancy. No statistically significant differences in vascular function including FMD absolute, PWV , and DC. |
Offspring sex and age at the time of outcome measurement, offspring BMI, birth weight, gestational age, and mode of delivery. Maternal age, nulliparity, smoking during pregnancy, prepregnancy BMI, education, and head of household social class. | SBP > 139 mm Hg or a DBP > 89 mm Hg, measured on at least two occasions after 20 weeks of gestation, with proteinuria, diagnosed if the protein reading on dipstick testing was at least 1 + (30 mg/dL), occurring at the same time as the elevated BP. |
| Geelhoed et al, 14 2010 | Cohort study | Preeclampsia (196) Normotensive pregnancy (5,082) |
9 y | SPB (mm Hg): mean difference (95% CI). Preeclampsia: 2.05 mm Hg (95%CI:0.72–3.38) higher than normotensive pregnancy. DPB (mm Hg): mean difference (95% CI). Preeclampsia: 1.00 mm Hg (95%CI: −0.01 to 2.01) higher than normotensive pregnancy. The association of preeclampsia with offspring SBP and DBP attenuated to null after adjusting for birth weight and gestational age. |
Offspring sex and age at the 9-y-old visit, maternal age at delivery, parental prepregnancy BMI, parity, social class, maternal smoking during pregnancy, and offspring weight, height at 9 y-old. | SBP > 139 mm Hg or a DBP > 89 mm Hg, measured on at least two occasions after 20 weeks of gestation, with proteinuria, diagnosed if the protein reading on dipstick testing was at least 1 + (30 mg/dL), occurring at the same time as the elevated BP. |
| Jayet et al, 16 2010 | Cohort study | Preeclampsia (48) Normal pregnancy (90) living at the same high altitude location |
Preeclampsia 13 + 7 y Normal pregnancy 14 + 7 y |
Pulmonary artery pressure (mm Hg): mean + SD Preeclampsia: 32.1 ± 5.6 mm Hg. Normal pregnancy: 25.3 ± 4.7 mm Hg. p < 0.001. Flow-mediated dilation of the brachial artery: mean + SD preeclampsia: 6.3 + 1.2%. Normal pregnancy: 8.3 + 1.4%; p < 0.0001. |
New-onset, persistent elevation of SBP and/or DBP > 140/90 mm Hg or a rise in blood pressure of 30/15 mm Hg from the baseline level that occurred after 20 weeks of gestation; proteinuria on consecutive dipstick measurements; and normalization of blood pressure and disappearance of proteinuria after delivery. | |
| Øglaend et al, 15 2009 | Case control study | Preeclampsia (181) Normotensive pregnancy (356) |
11–12 y | SBP (mm Hg): mean. Preeclampsia: 115.3 mm Hg. Normotensive pregnancy: 113.5 mm Hg, p = 0.03. DPB (mm Hg): mean. Preeclampsia: 66.4 mm Hg. Normotensive pregnancy: 65.3 mm Hg, p = 0.1. After adjustment, the difference in SBP was largely attenuated. |
Maternal BMI and blood pressure, offspring BMI. | At 20-week of gestation, DBP had to be increased by at least 25 mm Hg to a persistent pressure of at least 90 mm Hg, and proteinuria with dipstick + 1 or more should be present in at least one urine sample. |
| Kajantie et al, 21 2009 | Cohort study | Preeclampsia (384) Normotensive pregnancy (4,271) |
1934–1944 |
The crude hazard ratio for all forms of stroke: preeclampsia = 1.9 (1.2–3.0),
p
= 0.01.
Normotensive pregnancies as the comparison group. There was no evidence that preeclampsia was associated with coronary heart diseases in offspring. |
proteinuria + and a SBP of ≥ 140 mm Hg or DBP of ≥ 90 mm Hg. |
Abbreviations: BMI, body mass index; BP, blood pressure; CI, confidence interval; DBP, diastolic blood pressure; DC, distensibility coefficient; FMW, flow mediated dilation; IUGR, intrauterine growth restriction; MAP, mean arterial pressure; OR, odds ratio; PWV, pulse wave velocity; RR, risk ratio; SBP, systolic blood pressure; SD, standard deviation.
a
Early preterm preeclampsia: preeclampsia necessitating delivery at < 34 weeks; late preterm preeclampsia: preeclampsia necessitating delivery at 34 to 36 weeks; term preeclampsia: preeclampsia with the baby delivered at ≥37 weeks.