title: Biochemical cardiovascular risk factors after hypertensive pregnancy disorders: a systematic review and meta-analysis.
abstract: The objective of this study was to perform a systematic review and meta-analysis of studies assessing biochemical cardiovascular risk factors in women with previous hypertensive pregnancy disorders and women with previous normotensive pregnancies. Data were collected from PubMed and EMBASE (from inception to February 28, 2011) supplemented by manual searches of bibliographies. Included were cohort studies and case-control studies assessing biochemical cardiovascular risk factors in women with previous hypertensive pregnancy disorders compared with women with previous normotensive pregnancies. Of 2573 studies reviewed for eligibility, quality, and data extraction, 22 were included in the review, of which 15 could be meta-analyzed. The pooled mean differences for the outcomes of interest were 0.17 mmol/L (95% confidence interval [CI], 0.08-0.25 mmol/L) for glucose (10 studies), 3.46 mU/mL (95% CI, 2.34-4.58 mU/mL) for insulin (5 studies), 0.13 mmol/L (95% CI, 0.05-0.21) for triglycerides (10 studies), 0.22 mmol/L (95% CI, 0.11-0.33 mmol/L) for total cholesterol (11 studies), -0.11 mmol/L (95% CI, -0.18 to -0.04 mmol/L) for high-density lipoprotein cholesterol (10 studies), and 0.21 mmol/L (95% CI, 0.10-0.32) for low-density lipoprotein cholesterol (9 studies), all in the disadvantage in women with previous hypertensive pregnancy disorders. Analyses for preeclampsia alone showed similar results.
  After completing this CME activity, physicians should be better able to assess the long-term cardiovascular consequences after hypertensive pregnancy disorders, evaluate and interpret the evidence regarding biochemical cardiovascular risk factor assessment after pregnancy, and counsel women with a history of hypertensive pregnancy disorders as to the effectiveness of cardiovascular risk factor assessment in the primary prevention of cardiovascular disease.
  
  
  CONCLUSIONS
  Women with previous hypertensive pregnancy disorders have higher glucose, insulin, triglycerides, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol levels measured after pregnancy compared with women with previous normotensive pregnancies. These biochemical cardiovascular risk factors may identify women who will benefit from primary prevention of cardiovascular disease.
  
  
  BACKGROUND
  Obstetricians and gynecologists, family physicians.
authors.affiliation: Department of Obstetrics and Gynecology, Medical Center Haaglanden, The Hague, Vu University Medical Center, Amsterdam. herwie@mchaaglanden.nl
authors.forename: Wietske
authors.initials: W
authors.lastname: Hermes
authors.forename: Johannes C F
authors.initials: JC
authors.lastname: Ket
authors.forename: Maria G
authors.initials: MG
authors.lastname: van Pampus
authors.forename: Arie
authors.initials: A
authors.lastname: Franx
authors.forename: Marjolein V E
authors.initials: MV
authors.lastname: Veenendaal
authors.forename: Clara
authors.initials: C
authors.lastname: Kolster
authors.forename: Jouke T
authors.initials: JT
authors.lastname: Tamsma
authors.forename: Kitty W M
authors.initials: KW
authors.lastname: Bloemenkamp
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Ponjee
authors.forename: Evelien
authors.initials: E
authors.lastname: van der Hout
authors.forename: Hilde
authors.initials: H
authors.lastname: Ten Horn
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Loix
authors.forename: Ben Willem
authors.initials: BW
authors.lastname: Mol
authors.forename: Christianne J M
authors.initials: CJ
authors.lastname: de Groot
mesh_terms: D000419:Albuminuria / Q000453:epidemiology; D001786:Blood Glucose / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology*; D007328:Insulin / Q000097:blood; D011247:Pregnancy; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D007328:Insulin; D014280:Triglycerides; D002097:C-Reactive Protein; D002784:Cholesterol