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Family History of Hypertension, Cardiovascular Disease, or Diabetes and Risk of Developing Preeclampsia: A Systematic Review

Published:August 24, 2020DOI:https://doi.org/10.1016/j.jogc.2020.08.010

      ABSTRACT

      Preeclampsia is a severe pregnancy complication with high potential for adverse effects on maternal and fetal health during the perinatal period. It is also associated with an increased risk of maternal cardiovascular disease later in life. Development of preeclampsia can be decreased by prescribing low-dose aspirin to high-risk women. At present, maternal and pregnancy factors are used to assess the risk of preeclampsia. One additional factor that could add to the assessment of risk is a family history of hypertension, cardiovascular disease, or diabetes, especially for nulliparous women who do not have a pregnancy history to inform treatment decisions. Therefore, we conducted a systematic review to assess the association between family history of the aforementioned conditions and preeclampsia.
      Four databases including MEDLINE, EMBASE, the Cochrane Library, and CINAHL/pre-CINAHL were searched for observational studies that examined a family history of hypertension, cardiovascular disease, or diabetes in women with preeclampsia and in a control population. Studies were evaluated for quality using the Newcastle-Ottawa Scale. A total of 84 relevant studies were identified. A meta-analysis was not conducted due to suspected heterogeneity in the included studies.
      Most studies reported a positive association between a family history of hypertension or cardiovascular disease and the development of preeclampsia. The majority of studies examining family history of diabetes reported non-significant associations. Overall, family history of hypertension or cardiovascular disease is associated with a higher risk for developing preeclampsia and should be considered when assessing women in the first trimester for low-dose aspirin.

      RÉSUMÉ

      La pré-éclampsie est une grave complication de grossesse qui comporte un risque élevé d'effets défavorables sur la santé maternelle et fœtale en période périnatale. La pré-éclampsie est également associée à une augmentation du risque de maladies cardiovasculaires plus tard dans la vie chez la mère. Il est possible de réduire le risque de pré-éclampsie en prescrivant de l'aspirine à faible dose aux femmes à risque élevé. À l'heure actuelle, on a recours aux facteurs maternels et obstétricaux afin d’évaluer le risque de pré-éclampsie. Les antécédents familiaux d'hypertension, de maladies cardiovasculaires et de diabète, en particulier chez les femmes nullipares qui n'ont pas d'antécédents de grossesse pouvant orienter les décisions relatives au traitement, constituent un facteur supplémentaire dont on peut tenir compte lors de l’évaluation du risque. Nous avons donc mené une revue systématique afin de déterminer la corrélation entre la pré-éclampsie et les antécédents familiaux de ces maladies.
      Des recherches ont été effectuées dans quatre bases de données, notamment Medline, Embase et Cochrane Library, ainsi que CINAHL/pré-CINAHL, pour trouver des études observationnelles ayant examiné les antécédents familiaux d'hypertension, de maladies cardiovasculaires et de diabète chez les femmes atteintes de pré-éclampsie et au sein d'une population témoin. On a évalué la qualité des études au moyen de l’échelle de Newcastle-Ottawa. Au total, 84 études pertinentes ont été répertoriées. Aucune méta-analyse n'a été menée en raison d'une hétérogénéité soupçonnée des études retenues.
      La plupart des études indiquent une association positive entre les antécédents familiaux d'hypertension ou de maladies cardiovasculaires et la manifestation d'une pré-éclampsie. La majorité des études ayant examiné les antécédents familiaux de diabète ont indiqué une association non significative. Dans l'ensemble, les antécédents familiaux d'hypertension et de maladies cardiovasculaires sont associés à une augmentation du risque de pré-éclampsie. Il y a donc lieu d'en tenir compte au premier trimestre au moment d’évaluer si on doit envisager un traitement préventif par aspirine à faible dose.

      Keywords

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