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Published online by Cambridge University Press: 05 January 2022
Background: We aimed to evaluate the association between hypertensive disorders in pregnancy (HDP) and future risk of stroke, stroke death, and hypertension. Methods: Systematic searches were performed in MEDLINE and EMBASE up to April 27th, 2020. Exposure of interest included the different types of HDP. Outcomes of interest included hypertension incidence, stroke incidence, stroke subtype, and stroke mortality. Results: Eighteen cohort and 1 case-control studies involving >10 million women were included in the meta-analysis. Pooled hazard ratios with 95% confidence interval generally adjusted for age at delivery, ethnicity, and vascular risk factors are listed in table 1. Conclusions: Increasing severities of HDP carry higher hazards of hypertension and stroke years later. HDP, including gestational hypertension alone, are also associated with future stroke mortality.
Table 1.
Pooled adjusted hazard ratios of outcomes for all types of HDP.
| Outcome | Exposure | # of studies included | Pooled adjusted Hazard Ratio and 95% confidence intervals | Heterogeneity I2 |
| All stroke | All HDP | 5 | 1.43 (1.22-1.66) | 80.7% |
| Chronic hypertension in pregnancy | 1 | 3.40 (2.40-24.0) | NA | |
| Gestational hypertension | 5 | 1.38 (1.25-1.52) | 0% | |
| Preeclampsia | 12 | 1.56 (1.38-1.76) | 60.7% | |
| Ischemic stroke | All HDP | 3 | 1.72 (1.26-2.35) | 74.7% |
| Chronic hypertension in pregnancy | 2 | 2.40 (1.39-4.14) | 92.1% | |
| Gestational hypertension | 3 | 1.89 (1.34-2.67) | 61.1% | |
| Preeclampsia | 4 | 2.09 (1.63-2.66) | 74.9% | |
| Eclampsia | 1 | 4.58 (3.90-5.38) | NA | |
| Hemorrhagic stroke | All HDP | 1 | 1.17 (1.24-2.36) | NA |
| Gestational hypertension | 1 | 2.80 (1.31-5.99) | NA | |
| Preeclampsia | 2 | 1.42 (1.11-1.82) | 70.5% | |
| Stroke mortality | All HDP | 1 | 1.88 (1.53-2.32) | NA |
| Gestational hypertension | 1 | 2.97 (1.49-5.92) | NA | |
| Preeclampsia | 2 | 1.45 (0.81-2.60) | 66.0% | |
| Eclampsia | 1 | 1.56 (0.75-3.23) | NA | |
| Hypertension | All HDP | 2 | 2.83 (1.34-6.00) | 99.8% |
| Gestational hypertension | 3 | 2.97 (1.54-5.74) | 99.5% | |
| Preeclampsia | 6 | 2.55 (2.01-3.23) | 98.7% |
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