Despite blood pressure variation, most target organ damage during a hypertensive pregnancy continues throughout postpartum periods, according to findings published in the European Journal of Preventive Cardiology.
No reviews comparing temporal patterns of heart, brain, and blood vessel damage following hypertensive disorders of pregnancy have been found. Therefore, investigators sought to characterize heart, brain, and blood vessel damage due to hypertensive pregnancy from pregnancy through early and late postpartum periods, comparing changes that occur with variations in blood pressure. Cardiac changes were the primary outcome. Vascular changes, renal, and neural changes were secondary outcomes.
The investigators conducted a systematic review searching the EMBASE, Ovid/MEDLINE, and ClinicalTrials.gov databases from 2000 through February 2023 for articles in English concerning pregnancies and reporting on blood pressure trajectories or target organ damage during or after a hypertensive pregnancy. Primary research studies, trend studies, panel designs, cohort studies, and time-series designs were included. Abstracts, guidelines, reviews, and conference posters were excluded.
Articles were evaluated without meta-analysis (due to heterogeneity) using a vote-counting approach (comparing the number of positive studies with the number of negative studies) regardless of statistical significance. The investigators defined target organ damage as negative alterations affecting the function and structure of organ systems.
The investigators included 76 studies (over 1.7 million pregnancies) reporting on target organ damage or blood pressure trajectories during or after hypertensive pregnancy and found that, during hypertensive pregnancy, proteinuria and retinal microvasculature changes, white matter lesions, and left ventricular hypertrophy were first evident. Overall, during pregnancy and delivery, 7 studies reported systolic or diastolic dysfunction and 7 studies reported increased left ventricular remodeling. Temporally, 3 studies reported systolic or diastolic dysfunction and 4 studies reported increased left ventricular remodeling up to 1 year postpartum.
More than a decade postpartum, 1 study reported systolic or diastolic dysfunction and 2 studies reported increased left ventricular remodeling.
Overall, preeclampsia was the most common hypertensive disorder reported in the studies. Other disorders examined included low platelet count, elevated liver enzyme activity, gestational hypertension, and eclampsia. Risk of bias showed 18% of the studies with low risk and 82% of the included studies with moderate risk of bias according to the Newcastle-Ottawa scale.
Despite blood pressure reduction early in postpartum, retinal, cerebral, and cardiac changes were noted during early and late postpartum periods. The late postpartum period was the initial time cognitive dysfunction was reported.
Limitations of the study include a lack of meta-analysis narrowing conclusions that can be drawn, and the observational nature of the included studies prevents cause-and-effect inferences.
“The majority of target organ damage reported during a hypertensive pregnancy remains evident throughout the early and late postpartum period despite variation in blood pressure,” the investigators wrote. “Early peri-partum strategies may be required to prevent or reverse target organ damage in women who have had a hypertensive pregnancy.”
Cutler HR, Barr L, Sattwika PD, et al. Temporal patterns of pre- and post-natal target organ damage associated with hypertensive pregnancy: a systematic review. Eur J Prev Cardiol. Published online August 22, 2023. doi:10.1093/eurjpc/zwad275