Association between hypertensive disorders during pregnancy and elevated blood pressure in offspring: A systematic review and meta-analysis

Abstract

Hypertensive disorders during pregnancy (HDP) are associated with cardiovascular disease among mothers and offspring. This meta-analysis was conducted to further explore the associations between maternal HDP and offspring blood pressure (BP). The authors performed a search strategy in PubMed, Embase, Web of Science, and Cochrane library from database inception to January 2022. Twenty-four studies regarding HDP were included, with pregnancy-associated hypertension (PAH), preeclampsia (PE), gestational hypertension (GH), and chronic hypertension included in 12, 16, 6, and 3 studies, respectively. Offspring who were exposed to HDP and PAH in utero had higher systolic BP (2.46 mm Hg, 95% CI: 1.88-3.03 mm Hg; 2.70 mm Hg 95% CI: 1.89-3.51 mm Hg) and diastolic BP (1.38 mm Hg 95% CI: 0.94-1.83 mm Hg; 1.39 mm Hg 95% CI: 0.71-2.06 mm Hg) than those birthed to normotensive mothers. The offspring exposure to PE, GH, and chronic hypertension had higher systolic BP by 1.90 mm Hg (95% CI: 1.39-2.40 mm Hg), 2.47 mm Hg (95% CI: 1.59-3.35 mm Hg), and 7.85 mm Hg (95% CI: 4.10-11.61 mm Hg), respectively, and higher diastolic BP by 0.99 mm Hg (95% CI: 0.50-1.49 mm Hg), 1.04 mm Hg (95% CI: 0.60-1.47 mm Hg), and 2.92 mm Hg (95% CI: 0.98-4.86 mm Hg), respectively. An Egger test and funnel plot confirmed no significant publication bias. In conclusion, offspring exposure to all subtypes of HDP in utero led to higher BP than no exposure. It is necessary to investigate the potential mechanisms to clarify the roles of genetic and environmental factors in these associations, which could provide insight on preventing hypertension and related cardiovascular disease.

Keywords: blood pressure; hypertensive disorders during pregnancy; offspring; the developmental origins of health and disease.