Abstract：
Hypertensive disorders of pregnancy are associated with a long-term risk for cardiovascular disease among parous patients later in life. However, relatively little is known about whether hypertensive disorders of pregnancy are associated with an increased risk for ischemic stroke or hemorrhagic stroke in later life. This systematic review aimed to synthesize the available literature on the association between hypertensive disorders of pregnancy and the long-term risk for maternal stroke.
PubMed, Web of Science, and CINAHL were searched from inception to December 19, 2022.
Studies were only included if the following criteria were met: case-control or cohort studies that were conducted with human participants, were available in English, and that measured the exposure of a history of hypertensive disorders of pregnancy (preeclampsia, gestational hypertension, chronic hypertension, or superimposed preeclampsia) and the outcome of maternal ischemic stroke or hemorrhagic stroke.
Three reviewers extracted the data and appraised the study quality following the Meta-analyses of Observational Studies in Epidemiology guidelines and using the Newcastle-Ottawa scale for risk of bias assessment.
The primary outcome was any stroke (undifferentiated) and secondary outcomes included ischemic stroke and hemorrhagic stroke. The protocol for this systematic review was registered in the International Prospective Register of Systematic Reviews under identifier CRD42021254660. Of 24 studies included (10,632,808 study participants), 8 studies examined more than 1 outcome of interest. Hypertensive disorders of pregnancy were significantly associated with any stroke (adjusted risk ratio, 1.74; 95% confidence interval, 1.45-2.10). Preeclampsia was significantly associated with any stroke (adjusted risk ratio, 1.75; 95% confidence interval, 1.56-1.97), ischemic stroke (adjusted risk ratio, 1.74; 95% confidence interval, 1.46-2.06), and hemorrhagic stroke (adjusted risk ratio, 2.77; 95% confidence interval, 2.04-3.75). Gestational hypertension was significantly associated with any stroke (adjusted risk ratio, 1.23; 95% confidence interval, 1.20-1.26), ischemic stroke (adjusted risk ratio, 1.35; 95% confidence interval, 1.19-1.53), and hemorrhagic stroke (adjusted risk ratio, 2.66; 95% confidence interval, 1.02-6.98). Chronic hypertension was associated with ischemic stroke (adjusted risk ratio, 1.49; 95% confidence interval, 1.01-2.19).
In this meta-analysis, exposure to hypertensive disorders of pregnancy, including preeclampsia and gestational hypertension, seems to be associated with an increased risk for any stroke and ischemic stroke among parous patients in later life. Preventive interventions may be warranted for patients who experience hypertensive disorders of pregnancy to reduce their long-term risk for stroke.
PubMed, Web of Science, and CINAHL were searched from inception to December 19, 2022.
Studies were only included if the following criteria were met: case-control or cohort studies that were conducted with human participants, were available in English, and that measured the exposure of a history of hypertensive disorders of pregnancy (preeclampsia, gestational hypertension, chronic hypertension, or superimposed preeclampsia) and the outcome of maternal ischemic stroke or hemorrhagic stroke.
Three reviewers extracted the data and appraised the study quality following the Meta-analyses of Observational Studies in Epidemiology guidelines and using the Newcastle-Ottawa scale for risk of bias assessment.
The primary outcome was any stroke (undifferentiated) and secondary outcomes included ischemic stroke and hemorrhagic stroke. The protocol for this systematic review was registered in the International Prospective Register of Systematic Reviews under identifier CRD42021254660. Of 24 studies included (10,632,808 study participants), 8 studies examined more than 1 outcome of interest. Hypertensive disorders of pregnancy were significantly associated with any stroke (adjusted risk ratio, 1.74; 95% confidence interval, 1.45-2.10). Preeclampsia was significantly associated with any stroke (adjusted risk ratio, 1.75; 95% confidence interval, 1.56-1.97), ischemic stroke (adjusted risk ratio, 1.74; 95% confidence interval, 1.46-2.06), and hemorrhagic stroke (adjusted risk ratio, 2.77; 95% confidence interval, 2.04-3.75). Gestational hypertension was significantly associated with any stroke (adjusted risk ratio, 1.23; 95% confidence interval, 1.20-1.26), ischemic stroke (adjusted risk ratio, 1.35; 95% confidence interval, 1.19-1.53), and hemorrhagic stroke (adjusted risk ratio, 2.66; 95% confidence interval, 1.02-6.98). Chronic hypertension was associated with ischemic stroke (adjusted risk ratio, 1.49; 95% confidence interval, 1.01-2.19).
In this meta-analysis, exposure to hypertensive disorders of pregnancy, including preeclampsia and gestational hypertension, seems to be associated with an increased risk for any stroke and ischemic stroke among parous patients in later life. Preventive interventions may be warranted for patients who experience hypertensive disorders of pregnancy to reduce their long-term risk for stroke.
摘要：
目的：妊娠高血压疾病与妊娠晚期患者心血管疾病的长期风险相关。然而,对于妊娠高血压疾病是否与以后生活中缺血性卒中或出血性卒中的风险增加有关，人们知之甚少。本系统综述旨在综合有关妊娠期高血压疾病与母体卒中的长期风险之间关系的现有文献。
方法：PubMed，WebofScience,从开始到2022年12月19日，对andCINAHL进行了搜索。
方法：仅在符合以下标准的情况下才纳入研究：对人类参与者进行的病例对照或队列研究，有英文版本，并测量了妊娠高血压疾病史（先兆子痫，妊娠期高血压,慢性高血压,或叠加的先兆子痫）和母体缺血性中风或出血性中风的结果。
方法：在流行病学指南中对观察性研究进行meta分析，并使用纽卡斯尔-渥太华量表进行偏倚风险评估后，三位评审员提取了数据并评估了研究质量。
结果：主要结局是任何卒中（未分化），次要结局包括缺血性卒中和出血性卒中。本系统评价的方案已在国际前瞻性系统评价登记册中注册，标识符为CRD42021254660。包括24项研究（10,632,808名研究参与者），8项研究检查了超过1项感兴趣的结果。妊娠高血压疾病与任何中风显著相关(调整后的风险比，1.74；95%置信区间，1.45-2.10)。先兆子痫与任何卒中显著相关(调整后的风险比，1.75；95%置信区间，1.56-1.97),缺血性卒中（调整后的风险比，1.74；95%置信区间，1.46-2.06),和出血性中风(调整后的风险比，2.77；95%置信区间，2.04-3.75)。妊娠高血压与任何卒中显著相关(调整后的风险比，1.23；95%置信区间，1.20-1.26),缺血性卒中（调整后的风险比，1.35；95%置信区间，1.19-1.53),和出血性中风(调整后的风险比，2.66；95%置信区间，1.02-6.98)。慢性高血压与缺血性卒中相关(调整后的风险比，1.49；95%置信区间，1.01-2.19).
结论：在本荟萃分析中，暴露于妊娠高血压疾病，包括先兆子痫和妊娠期高血压,似乎与患者晚年发生卒中和缺血性卒中的风险增加有关.对于经历妊娠高血压疾病的患者，可能需要采取预防性干预措施，以降低其中风的长期风险。
方法：PubMed，WebofScience,从开始到2022年12月19日，对andCINAHL进行了搜索。
方法：仅在符合以下标准的情况下才纳入研究：对人类参与者进行的病例对照或队列研究，有英文版本，并测量了妊娠高血压疾病史（先兆子痫，妊娠期高血压,慢性高血压,或叠加的先兆子痫）和母体缺血性中风或出血性中风的结果。
方法：在流行病学指南中对观察性研究进行meta分析，并使用纽卡斯尔-渥太华量表进行偏倚风险评估后，三位评审员提取了数据并评估了研究质量。
结果：主要结局是任何卒中（未分化），次要结局包括缺血性卒中和出血性卒中。本系统评价的方案已在国际前瞻性系统评价登记册中注册，标识符为CRD42021254660。包括24项研究（10,632,808名研究参与者），8项研究检查了超过1项感兴趣的结果。妊娠高血压疾病与任何中风显著相关(调整后的风险比，1.74；95%置信区间，1.45-2.10)。先兆子痫与任何卒中显著相关(调整后的风险比，1.75；95%置信区间，1.56-1.97),缺血性卒中（调整后的风险比，1.74；95%置信区间，1.46-2.06),和出血性中风(调整后的风险比，2.77；95%置信区间，2.04-3.75)。妊娠高血压与任何卒中显著相关(调整后的风险比，1.23；95%置信区间，1.20-1.26),缺血性卒中（调整后的风险比，1.35；95%置信区间，1.19-1.53),和出血性中风(调整后的风险比，2.66；95%置信区间，1.02-6.98)。慢性高血压与缺血性卒中相关(调整后的风险比，1.49；95%置信区间，1.01-2.19).
结论：在本荟萃分析中，暴露于妊娠高血压疾病，包括先兆子痫和妊娠期高血压,似乎与患者晚年发生卒中和缺血性卒中的风险增加有关.对于经历妊娠高血压疾病的患者，可能需要采取预防性干预措施，以降低其中风的长期风险。
