Temporal Patterns of Pre- and Post-Natal Target Organ Damage Associated Wih Hypertensive Pregnancy: A Systematic Review.
Cutler HR., Barr L., Sattwika PD., Frost A., Alkhodari M., Kitt J., Lapidaire W., Lewandowski AJ., Leeson P.
AIMS: Hypertensive pregnancy is associated with increased risks of developing a range of vascular disorders in later life. Understanding when hypertensive target organ damage first emerges could guide optimal timing of preventive interventions. This review identifies evidence of hypertensive target organ damage across cardiac, vascular, cerebral, and renal systems at different time points from pregnancy to postpartum. METHODS: Systematic review of Ovid/MEDLINE, EMBASE and ClinicalTrials.gov up to and including February 2023 including review of reference lists. Identified articles underwent evaluation via a synthesis without meta-analysis using a vote-counting approach based on direction of effect, regardless of statistical significance. Risk of bias was assessed for each outcome domain and only higher quality studies were used for final analysis. RESULTS: From 7644 articles, 76 studies, including data from 1,742,698 pregnancies, were identified of high quality that reported either blood pressure trajectories or target organ damage during or after a hypertensive pregnancy. Left ventricular hypertrophy, white matter lesions, proteinuria and retinal microvasculature changes were first evident in women during a hypertensive pregnancy. Cardiac, cerebral and retinal changes were also reported in studies performed during the early and late post-partum period despite reduction in blood pressure early post-partum. Cognitive dysfunction was first reported late post-partum. CONCLUSIONS: The majority of target organ damage reported during a hypertensive pregnancy remains evident throughout the early and late post-partum period despite variation in blood pressure. Early peri-partum strategies may be required to prevent or reverse target organ damage in women who have had a hypertensive pregnancy.