Systematic review of cardiovascular intervention studies in women after Preeclampsia

Preeclampsia affects 2-4% of pregnancies worldwide and is associated with significant morbidity and mortality. It is now known that PE also increases risk of later-life cardiovascular disease (CVD). Current international guidelines acknowledge this risk. However, all guidelines differ with no consensus on specific risk-reduction strategies in this high-risk group. The aim of this review was to assess efficacy of all interventions that have been trialled in women with a history of PE to reduce risk of long-term CVD.

A systematic search of MEDLINE, EMBASE and CINAHL was performed according to PRISMA guidelines, to identify all studies which explored interventions to reduce risk of CVD in women with a history of PE.

8 studies (n = 728 women) were included in the final analysis. 4 studies explored exercise interventions, 2 assessed web-based interventions, 1 studied a multidisciplinary team (MDT) clinic and 1 studied telemonitored home blood pressure (BP) monitoring. Studies were heterogeneous with respect to duration, timing postpartum and outcomes of interest. Overall, exercise improved physical fitness, endothelial and autonomic function and vascular stiffness. Web-based interventions were well received but did not reduce CVD risk factors. Telemonitored home BP monitoring significantly lowered BP. A MDT Postpartum Preeclampsia clinic reduced CVD risk factors.

This review highlights the challenges associated with CVD risk reduction in women with a history of PE. Optimal strategy is likely to involve early education, a dedicated exercise program and web-based platform. Larger studies are required to determine optimal strategies for CVD risk prevention in this cohort.