Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine University of Oxford Oxford UK.
Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada Yogyakarta Indonesia.
J Am Heart Assoc. 2024 Nov 5;13(21):e033617. doi: 10.1161/JAHA.123.033617. Epub 2024 Oct 25.
Hypertensive pregnancies are associated with an increased risk of cardiovascular and neurological diseases in the offspring during later life. However, less is known about the potential impact on multi-organ phenotypes in offspring before disease symptoms occur. The objective of this systematic review was to determine the associations of fetal exposure to maternal hypertensive pregnancy with multi-organ phenotypes across developmental stages.
Ovid MEDLINE, EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), WoS, Scopus, CINAHL, and ClinicalTrials.gov were systematically searched until February 2024. Records were independently screened by 2 authors. Studies reporting on the structure or function of the heart, blood vessels, brain, liver, and kidneys in offspring of hypertensive pregnancies compared with a normotensive control population were included. Risk of bias was assessed using the Newcastle-Ottawa Scale. Extracted data were presented using harvest plots. Seventy-three studies including 7091 offspring of hypertensive pregnancies and 42 164 controls were identified that met the inclusion criteria. Thirty-two studies were investigations in fetuses, 24 in neonates and infants, 12 in children, 2 in adolescents, and 3 in adults. Offspring of hypertensive pregnancies had structural and functional changes in the heart compared with controls in some studies across developmental stages. Offspring of hypertensive pregnancies also had smaller occipital and parietal vessels, higher aortic intima-media thickness, and lower retinal arteriolar-to-venular ratio. Some conflicting evidence existed for other phenotypical alterations.
There is still inconsistent evidence of multi-organ structural and functional differences in offspring of hypertensive pregnancies. The evidence base could therefore be further strengthened through well-designed and conducted prospective studies.
www.crd.york.ac.uk. Unique Identifier: CRD42023387550.
高血压妊娠与后代晚年心血管和神经系统疾病的风险增加有关。然而，对于在疾病症状出现之前，胎儿暴露于母体高血压妊娠对后代多器官表型的潜在影响知之甚少。本系统评价的目的是确定胎儿暴露于母体高血压妊娠与多器官表型在各发育阶段的相关性。
我们对 Ovid MEDLINE、EMBASE、CENTRAL（Cochrane 对照试验中心注册库）、WoS、Scopus、CINAHL 和 ClinicalTrials.gov 进行了系统检索，检索截至 2024 年 2 月。由 2 位作者独立筛选记录。纳入的研究报告了与正常血压对照组相比，高血压妊娠后代的心脏、血管、大脑、肝脏和肾脏的结构或功能。使用 Newcastle-Ottawa 量表评估偏倚风险。使用 harvest plots 呈现提取的数据。确定了 73 项研究，其中包括 7091 名高血压妊娠后代和 42164 名对照，这些研究符合纳入标准。其中 32 项研究是在胎儿期进行的，24 项研究是在新生儿和婴儿期进行的，12 项研究是在儿童期进行的，2 项研究是在青少年期进行的，3 项研究是在成人期进行的。一些研究表明，与对照组相比，高血压妊娠后代的心脏存在结构和功能变化。高血压妊娠后代的枕部和顶部血管也较小，主动脉内中膜厚度较高，视网膜小动脉-小静脉比值较低。其他表型改变的证据存在一些矛盾。
目前仍有证据表明高血压妊娠后代存在多器官结构和功能差异，但证据基础仍可以通过精心设计和实施的前瞻性研究进一步加强。
