title: Systematic review and metaanalysis on nonclassic cardiovascular biomarkers after hypertensive pregnancy disorders.
abstract: OBJECTIVE
  The aim of this study was to investigate which nonclassic cardiovascular biomarkers are associated with persistent endothelial dysfunction after pregnancy in women with a history of hypertensive pregnancy disorders compared with women with uncomplicated pregnancies.
  
  
  METHODS
  This was a systematic review and metaanalysis of observational studies. A search was performed in PubMed, Embase, Cochrane, and Cinahl including articles from inception to Feb. 27, 2013. Included were cohort studies and case-control studies. Cases were women with a history of hypertension in pregnancy, control subjects were women with a history of uncomplicated pregnancies. Of the 3136 found, 21 studies on 16 nonclassic cardiovascular biomarkers are described in this review; 12 studies on 5 biomarkers were included in the metaanalysis.
  
  
  RESULTS
  Women with a history of hypertensive pregnancy disorders had a higher homocysteine level compared with women with a history of uncomplicated pregnancies (5 studies; pooled mean difference, 0.77 ng/mL; 95% confidence interval, 0.27-1.26; P < .01). For the other nonclassic cardiovascular biomarkers including markers in areas of inflammation, thrombosis, and angiogenesis, we found no significant differences.
  
  
  CONCLUSIONS
  This review and metaanalysis showed that women with a history of hypertensive pregnancy disorders have higher homocysteine levels compared with women with a history of uncomplicated pregnancies. These data suggest persistent endothelial alteration after pregnancies complicated by hypertensive disorders.
authors.affiliation: Department of Obstetrics and Gynecology, Medical Center, VU University, Amsterdam, The Netherlands; Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. Electronic address: vsvisser@hotmail.com.
authors.forename: Sanne
authors.initials: S
authors.lastname: Visser
authors.affiliation: Department of Obstetrics and Gynecology, Medical Center, VU University, Amsterdam, The Netherlands; Department of Obstetrics and Gynecology, Medical Center Haaglanden, the Hague, The Netherlands.
authors.forename: Wietske
authors.initials: W
authors.lastname: Hermes
authors.affiliation: Medical Library, VU University, Amsterdam, The Netherlands.
authors.forename: Johannes C F
authors.initials: JC
authors.lastname: Ket
authors.affiliation: Medical Library, VU University, Amsterdam, The Netherlands.
authors.forename: René H J
authors.initials: RH
authors.lastname: Otten
authors.affiliation: Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Maria G
authors.initials: MG
authors.lastname: van Pampus
authors.affiliation: Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Kitty W M
authors.initials: KW
authors.lastname: Bloemenkamp
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Arie
authors.initials: A
authors.lastname: Franx
authors.affiliation: Department of Obstetrics and Gynecology, Amsterdam Medical Center, Amsterdam, The Netherlands.
authors.forename: Ben W
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of Obstetrics and Gynecology, Medical Center, VU University, Amsterdam, The Netherlands.
authors.forename: Christianne J M
authors.initials: CJ
authors.lastname: de Groot
mesh_terms: D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D006973:Hypertension / Q000097:blood; D046110:Hypertension, Pregnancy-Induced / Q000097:blood*; D015233:Models, Statistical; D011247:Pregnancy
chemical_list: D015415:Biomarkers; D006710:Homocysteine
keywords: cardiovascular risk; hypertensive pregnancy disorders; preeclampsia; pregnancy-induced hypertension