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The claim checked: Severe preeclampsia raises the later risk of kidney and heart disease Hear it at 48:38
All ten studies found that women who had preeclampsia face a higher risk of heart disease later in life. A pooled analysis put the risk of heart disease at 2.16 times that of other women. In Norway, deaths from heart disease ran 8.12 times higher after preeclampsia with an early birth.
Computed from 10 studies that test this point, each judged by two readers, in full. 10 more studies are waiting for a full read and do not count yet.
“have a longer term risk of kidney disease as well as cardiovascular disease.”
pooled analysis · 2007 · landmark
“The relative risk of fatal or non-fatal ischaemic heart disease in women with previous pre-eclampsia was over twice that of women who had not developed pre-eclampsia (2.16, 1.86 to 2.52).”
Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ
Who: Women in prospective and retrospective cohort studies with vs without pre-eclampsia
PMID 17975258
other primary study · 2001 · landmark
“The increased risk of death among women who had pre-eclampsia and a preterm delivery was more marked among women who died from cardiovascular causes: the risk in this group was 8.12-fold higher (4.31 to 15.33) than that in the reference group (women who died from cardiovascular causes and who had term pregnancies without pre-eclampsia).”
Long term mortality of mothers and fathers after pre-eclampsia: population based cohort study. BMJ
Who: Mothers and fathers of all first births recorded in the Medical Birth Registry of Norway, 1967-1992
PMID 11719411
other primary study · 2003 · landmark
“Women with a history of gestational hypertension or of pre-eclampsia or eclampsia are at increased risk of hypertensive and associated diseases in later life.”
Hypertensive diseases of pregnancy and risk of hypertension and stroke in later life: results from cohort study. BMJ
Who: women in Aberdeen, Scotland, who delivered a first live singleton 1951-1970, with pre-eclampsia/eclampsia, gestational hypertension, or normotensive pregnancy (matched for age and year)
PMID 12702615
trial or observed group · 2010 · landmark
“Observed preeclampsia was independently associated with cardiovascular disease death (Mutually adjusted Hazard Ratio = 2.14 (1.29 to 3.57)).”
Preeclampsia and cardiovascular disease death: prospective evidence from the child health and development studies cohort. Hypertension
Who: 14,403 women in the Child Health and Development Studies pregnancy cohort (Kaiser Permanente, California, pregnant 1959-1967), no prior heart conditions, median age 26 at enrollment
PMID 20516394
systematic review · 2020 · landmark
“Overall, women with a history of pre-eclampsia (both moderate and severe pre-eclampsia) were at an increased risk of mortality and morbidity from composite cardiovascular disease compared with those without a history of pre-eclampsia ( table 1 ).”
Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review. BMJ
Who: Women in systematic reviews and meta-analyses of reproductive risk factors (adverse pregnancy outcomes and fertility issues) and later cardiovascular disease
PMID 33028606
trial or observed group · 2019 · landmark
“In analysis of time-to-first incident cardiovascular diagnosis, prior HDP was associated with a hazard ratio (HR) of 1.3 (95% CI 1.04-1.6, P=0.02).”
Long-Term Cardiovascular Risk in Women With Hypertension During Pregnancy. J Am Coll Cardiol
Who: Parous UK Biobank women aged 40-69 years, with vs without a prior hypertensive disorder of pregnancy (gestational hypertension, preeclampsia, eclampsia or HELLP), 94% white
PMID 31727424
other primary study · 2023 · landmark
“Furthermore, both HDP subtypes of gestational hypertension and preeclampsia/eclampsia displayed consistent associations with higher risk of CAD.”
Association of Hypertensive Disorders of Pregnancy With Future Cardiovascular Disease. JAMA Netw Open
Who: genome-wide summary data of European ancestry: FinnGen exposure GWAS (4743 preeclampsia/eclampsia cases, 136,325 controls) and outcome GWAS for CAD, ischemic stroke, heart failure and atrial fibrillation
PMID 36800181
trial or observed group · 2012
“Women with pre-eclampsia in the first pregnancy had nearly a doubling of cardiovascular mortality risk overall, compared with those who did not have pre-eclampsia (adjusted hazard ratio 1.9, 95% confidence interval 1.6 to 2.2; table 1), but no increase in other causes of death (0.93, 0.86 to 1.00).”
Cardiovascular mortality after pre-eclampsia in one child mothers: prospective, population based cohort study. BMJ
Who: Norwegian women with a first singleton birth 1967-2002 in the Medical Birth Registry, linked to the Cause of Death Registry; 34,824 had pre-eclampsia
PMID 23186909
other primary study · 2018
“HDP and parity remained independently associated with 10-year risk of a first CVD event when added to a model with established CVD risk factors—age, total cholesterol, HDL cholesterol, SBP, treatment for high blood pressure, current smoking, and diabetes.”
Hypertensive Disorders of Pregnancy and 10-Year Cardiovascular Risk Prediction. J Am Coll Cardiol
Who: US female registered nurses aged 40 and over, free of prior CVD, in the Nurses' Health Study II (mostly white)
PMID 30190003
other primary study · 2019
“The corresponding HRs were 1.66 (95% CI, 1.34-2.06) for women experiencing preeclampsia and 1.43 (95% CI, 1.09-1.88) for women experiencing gestational hypertension only.”
Association of Conventional Cardiovascular Risk Factors With Cardiovascular Disease After Hypertensive Disorders of Pregnancy: Analysis of the Nord-Trøndelag Health Study. JAMA Cardiol
Who: parous women in the Nord-Trondelag Health Study (HUNT), Norway, linked to the Medical Birth Registry, followed from age 40
PMID 31188397
None.
None.
Nine of ten studies found a higher risk of kidney disease after preeclampsia. A pooled analysis put the risk of kidney failure at 4.90 times higher, after allowing for other causes. One study notes that obesity may explain part of the link.
Computed from 10 studies that test this point, each judged by two readers, in full. 7 more studies are waiting for a full read and do not count yet.
pooled analysis · 2020 · landmark
“The pooled crude risk ratio for preeclampsia and ESKD was 6.16 (95% CI, 4.42-8.57) and the pooled adjusted risk ratio (aRR) was 4.90 (95% CI, 3.56-6.74) ( Figure 2 ).”
Adverse Pregnancy Outcomes and Long-term Maternal Kidney Disease: A Systematic Review and Meta-analysis. JAMA Netw Open
Who: Women in case-control and cohort studies with vs without adverse pregnancy outcomes (preeclampsia, other HDP, preterm delivery, low birth weight, GDM)
PMID 32049292
other primary study · 2013
“Women with preeclampsia or eclampsia had a higher risk of end-stage renal disease (adjusted HR 14.0, 95% CI 9.43–20.7) than women who had gestational hypertension only (adjusted HR 9.03, 95% CI 5.20–15.7).”
Association between hypertensive disorders during pregnancy and end-stage renal disease: a population-based study. CMAJ
Who: Taiwanese women aged 19-40 with a hypertensive disorder in their first pregnancy (1998-2009) and no prior hypertension, diabetes, kidney disease or lupus, vs age- and year-matched women without
PMID 23339156
trial or observed group · 2019
“Our study found strong, statistically significant associations between pre-eclampsia and later chronic kidney disease, hypertensive kidney disease, and glomerular and proteinuric disease, with stronger associations for earlier onset of pre-eclampsia.”
Pre-eclampsia and risk of later kidney disease: nationwide cohort study. BMJ
Who: All women in Denmark with at least one pregnancy of 20+ weeks ending in live birth or stillbirth, 1978-2015, without prior kidney, cardiovascular, hypertensive or autoimmune disease
PMID 31036557
other primary study · 2017
“Our findings confirm that there is a sizable association between preeclampsia and ESRD; however, obesity is a previously unexplored confounder.”
Preeclampsia and ESRD: The Role of Shared Risk Factors. Am J Kidney Dis
Who: Women who gave birth in Olmsted County, Minnesota, 1976-2010; ESRD cases from the US Renal Data System matched 1:2 to controls on birth year, age at first pregnancy and parity; preeclampsia confirmed by medical record review
PMID 27707553
trial or observed group · 2019
“We report that healthy women with preeclampsia are at a 5-fold increased risk of ESKD compared with parous women with no preeclampsia.”
Preeclampsia and risk of end stage kidney disease: A Swedish nationwide cohort study. PLoS Med
Who: Swedish women with singleton live births 1982-2012 and no CKD, CVD, hypertension or diabetes before first pregnancy
PMID 31361741
other primary study · 2020
“Women who had ever experienced preeclampsia were at higher risk of developing CKD compared with women who never had preeclampsia (aHR 1.92, 95% CI 1.83–2.03, p < 0.001).”
Hypertensive disorders of pregnancy and the risk of chronic kidney disease: A Swedish registry-based cohort study. PLoS Med
Who: Women with singleton live births in Sweden 1973-2012 (Swedish Medical Birth Register), excluding pre-pregnancy kidney disease, cardiovascular disease, chronic hypertension, diabetes and related conditions
PMID 32797043
other primary study · 2016
“There appears to be a small but significant increased risk of CKD in women with preeclampsia.”
Long term effects of gestational hypertension and pre-eclampsia on kidney function: Record linkage study. Pregnancy Hypertens
Who: primiparous women born on or before June 1969 delivering in Aberdeen (Grampian, Scotland), linked to renal biochemistry, hospital, renal registry and death records; 811 with pre-eclampsia, 3583 with gestational hypertension, 10,457 normotensive
PMID 27939480
other primary study · 2012
“We conclude that it is the women with preeclampsia who have an increased risk of ESRD and that we cannot find evidence for familial contributions to the increased risk of ESRD after preeclampsia.”
Familial factors in the association between preeclampsia and later ESRD. Clin J Am Soc Nephrol
Who: Norwegian women (and men) with a registered first birth 1967-2008 in the Medical Birth Registry of Norway, linked to siblings, children and the Norwegian Renal Registry
PMID 22956264
other primary study · 2024
“This subgroup was 7.91 (7.11–8.80) times more likely to develop chronic kidney disease during follow‐up, 1.78 (1.55–2.04) times more likely to die (all causes), and 4.37 (2.88–6.63) times more likely to die of cardiovascular death.”
Early Mortality, Cardiovascular, and Renal Diseases in Women's Lives Following Hypertensive Disorders of Pregnancy: The Prospective Nationwide Study CONCEPTION. J Am Heart Assoc
Who: all women in France with a first birth after 22 weeks in 2010-2018 in the CONCEPTION cohort (national health insurance data), without prior cardiovascular or renal disease; 100,348 had preeclampsia
PMID 38563390
other primary study · 2017
“Our data indicate that mainly persistent albuminuria would classify 13.7 % women after PE as having CKD.”
Prevalence of chronic kidney disease after preeclampsia. J Nephrol
Who: Primiparous women with a history of preeclampsia (mostly early-onset) at postpartum screening, Maastricht University Medical Center, without prior hypertension, diabetes or kidney disease
PMID 27491315
None.
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