Impaired Flow-Mediated Dilation Before, During, and After Preeclampsia: A Systematic Review and Meta-Analysis

Tracey L Weissgerber, Natasa M Milic, Jelena S Milin-Lazovic, Vesna D Garovic, Tracey L Weissgerber, Natasa M Milic, Jelena S Milin-Lazovic, Vesna D Garovic

Abstract

Endothelial dysfunction is believed to play a critical role in preeclampsia; however, it is unclear whether this dysfunction precedes the pregnancy or is caused by pathophysiological events in early pregnancy. It is also unclear for how long vascular dysfunction may persist postpartum and whether it represents a mechanism linking preeclampsia with future cardiovascular disease. Our objective was to determine whether women with preeclampsia had worse vascular function compared with women who did not have preeclampsia by performing a systematic review and meta-analysis of studies that examined endothelial dysfunction using flow-mediated dilation. We included studies published before May 29, 2015, that examined flow-mediated dilation before, during, or after preeclampsia. Differences in flow-mediated dilation between study groups were evaluated by standardized mean differences. Out of 610 abstracts identified through PubMED, EMBASE, and Web of Science, 37 studies were eligible for the meta-analysis. When compared with women who did not have preeclampsia, women who had preeclampsia had lower flow-mediated dilation before the development of preeclampsia (≈20-29 weeks gestation), at the time of preeclampsia, and for 3 years postpartum, with the estimated magnitude of the effect ranging between 0.5 and 3 standard deviations. Similar effects were observed when the analysis was limited to studies that excluded women with chronic hypertension, smokers, or both. Vascular dysfunction predates preeclampsia and may contribute to its pathogenesis. Future studies should address whether vascular changes that persist after preeclamptic pregnancies may represent a mechanistic link with increased risk for future cardiovascular disease.

Keywords: cardiovascular disease; endothelium; flow-mediated dilation; hypertension; preeclampsia; pregnancy.

Conflict of interest statement

Conflict of Interest/Disclosures

The authors have nothing to disclose.

© 2015 American Heart Association, Inc.

Figures

Figure 1
Figure 1
Study Flow Chart aOne study obtained measurements at the time of disease and post-partum bOne study obtained measurements at 3 time points. Five studies obtained measurements at two time points.
Figure 2
Figure 2
Standardized Mean Difference in FMD Among Studies Conducted Before the Clinical Diagnosis of Preeclampsia aAll participants had systemic autoimmune disease
Figure 3
Figure 3
Standardized Mean Difference in FMD Among Studies Conducted At the Time of Preeclampsia
Figure 4
Figure 4
Standardized Mean Difference in FMD Among Studies Conducted After Preeclampsia

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