Pre-eclampsia and long-term health outcomes for mother and infant: an umbrella review

Abstract

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.

Keywords: Epidemiological credibility; health outcomes; meta-analysis; pre-eclampsia; umbrella review.