The effect of previous history of Pre-Eclampsia on subclinical carotid atherosclerosis up to 20 years Postpartum: A systematic review and Meta-Analysis.

Background: During the last two decades, a few studies have evaluated the common carotid artery (CCA) intima-media thickness (IMT) in women with previous history of pre-eclampsia (pPE) in comparison to women with uncomplicated pregnancies, providing not univocal results. This systematic review and meta-analysis has been designed to summarize the main findings of these studies and to examine the overall influence of pPE on CCA-IMT.

Methods: All studies assessing CCA-IMT in pPE women in comparison to women who had uncomplicated pregnancies, selected from PubMed and EMBASE databases, were included. Studies evaluating women with previous history of early-onset (EO) or late-onset (LO) PE vs healthy controls were separately analyzed. Continuous data (CCA-IMT) were pooled as a standardized mean difference (SMD) comparing pPE group with healthy controls. The subtotal and overall SMDs of CCA-IMT were calculated using the random-effect model.

Results: The full-texts of 12 studies with 583 pPE women and 610 healthy controls were analyzed. The average time after delivery was 8.5 yrs (range 1.1-20 yrs). The average CCA-IMT was significantly increased in pPE women than healthy controls in five studies (41.7 % of total), whereas it was similar between the two study groups or surprisingly reduced in pPE women vs controls in more than half of studies (58.3 % of total). The effect of pPE on CCA-IMT was very small for the studies including women with previous LO-PE (subtotal SMD 0.067, 95 %CI -0.339,0.472, P = 0.75) and small for those analyzing women with previous EO-PE (subtotal SMD 0.250, 95 %CI-0.231,0.732, P = 0.31). Overall, the effect of pPE on CCA-IMT was small and not statistically significant (SMD 0.143, 95 %CI -0.167,0.453, P = 0.37). Substantial heterogeneity was detected for the included studies, with an overall I statistic value of 81 % (P < 0.001). Egger's test for a regression intercept yielded a P-value of 0.58, indicating no publication bias. On meta-regression analysis, none of the moderators and/or potential confounders was significantly associated with effect modification (all P > 0.05).

Conclusions: Women with previous history of PE have an increased burden of cardiovascular risk factors, but do not appear to be affected by significant subclinical carotid atherosclerosis, up to 20 years postpartum.