Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis.
OBJECTIVE
To quantify the risk of future cardiovascular diseases, cancer, and mortality after pre-eclampsia.


METHODS
Systematic review and meta-analysis.


METHODS
Embase and Medline without language restrictions, including papers published between 1960 and December 2006, and hand searching of reference lists of relevant articles and reviews for additional reports.


METHODS
Prospective and retrospective cohort studies were included, providing a dataset of 3,488,160 women, with 198,252 affected by pre-eclampsia (exposure group) and 29,495 episodes of cardiovascular disease and cancer (study outcomes).


RESULTS
After pre-eclampsia women have an increased risk of vascular disease. The relative risks (95% confidence intervals) for hypertension were 3.70 (2.70 to 5.05) after 14.1 years weighted mean follow-up, for ischaemic heart disease 2.16 (1.86 to 2.52) after 11.7 years, for stroke 1.81 (1.45 to 2.27) after 10.4 years, and for venous thromboembolism 1.79 (1.37 to 2.33) after 4.7 years. No increase in risk of any cancer was found (0.96, 0.73 to 1.27), including breast cancer (1.04, 0.78 to 1.39) 17 years after pre-eclampsia. Overall mortality after pre-eclampsia was increased: 1.49 (1.05 to 2.14) after 14.5 years.


CONCLUSIONS
A history of pre-eclampsia should be considered when evaluating risk of cardiovascular disease in women. This association might reflect a common cause for pre-eclampsia and cardiovascular disease, or an effect of pre-eclampsia on disease development, or both. No association was found between pre-eclampsia and future cancer.
Bellamy
Leanne
L
Imperial College School of Medicine, London.
Casas
Juan-Pablo
JP
Hingorani
Aroon D
AD
Williams
David J
DJ
D000367:Age Factors; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009369:Neoplasms / Q000209:etiology / Q000401:mortality; D011225:Pre-Eclampsia / Q000401:mortality*; D011247:Pregnancy; D012307:Risk Factors