Division of Cardiology, IRCCS MultiMedica, Milan, Italy.
Laboratory of Innate Immunity, IRCCS MultiMedica, Milan, Italy; Laboratory of Immunology and General Pathology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
Eur J Obstet Gynecol Reprod Biol. 2024 Dec;303:250-258. doi: 10.1016/j.ejogrb.2024.11.001. Epub 2024 Nov 3.
During the last two decades, a few studies have evaluated the common carotid artery (CCA) intima-media thickness (IMT) in women with previous history of pre-eclampsia (pPE) in comparison to women with uncomplicated pregnancies, providing not univocal results. This systematic review and meta-analysis has been designed to summarize the main findings of these studies and to examine the overall influence of pPE on CCA-IMT.
All studies assessing CCA-IMT in pPE women in comparison to women who had uncomplicated pregnancies, selected from PubMed and EMBASE databases, were included. Studies evaluating women with previous history of early-onset (EO) or late-onset (LO) PE vs healthy controls were separately analyzed. Continuous data (CCA-IMT) were pooled as a standardized mean difference (SMD) comparing pPE group with healthy controls. The subtotal and overall SMDs of CCA-IMT were calculated using the random-effect model.
The full-texts of 12 studies with 583 pPE women and 610 healthy controls were analyzed. The average time after delivery was 8.5 yrs (range 1.1-20 yrs). The average CCA-IMT was significantly increased in pPE women than healthy controls in five studies (41.7 % of total), whereas it was similar between the two study groups or surprisingly reduced in pPE women vs controls in more than half of studies (58.3 % of total). The effect of pPE on CCA-IMT was very small for the studies including women with previous LO-PE (subtotal SMD 0.067, 95 %CI -0.339,0.472, P = 0.75) and small for those analyzing women with previous EO-PE (subtotal SMD 0.250, 95 %CI-0.231,0.732, P = 0.31). Overall, the effect of pPE on CCA-IMT was small and not statistically significant (SMD 0.143, 95 %CI -0.167,0.453, P = 0.37). Substantial heterogeneity was detected for the included studies, with an overall I statistic value of 81 % (P < 0.001). Egger's test for a regression intercept yielded a P-value of 0.58, indicating no publication bias. On meta-regression analysis, none of the moderators and/or potential confounders was significantly associated with effect modification (all P > 0.05).
Women with previous history of PE have an increased burden of cardiovascular risk factors, but do not appear to be affected by significant subclinical carotid atherosclerosis, up to 20 years postpartum.
在过去的二十年中，已有少数研究评估了既往有子痫前期（PE）病史的女性与无并发症妊娠女性的颈总动脉内膜中层厚度（CCA-IMT），但结果并不一致。本系统评价和荟萃分析旨在总结这些研究的主要发现，并探讨既往 PE 对 CCA-IMT 的总体影响。
从 PubMed 和 EMBASE 数据库中选择了所有评估既往有 PE 病史的女性与无并发症妊娠女性 CCA-IMT 的研究。分别分析了评估既往有早发型（EO）或晚发型（LO）PE 病史的女性与健康对照组的研究。连续数据（CCA-IMT）以比较 pPE 组与健康对照组的标准化均数差值（SMD）进行汇总。使用随机效应模型计算 CCA-IMT 的亚总和总体 SMD。
共分析了 12 项研究的全文，其中包括 583 例 pPE 女性和 610 例健康对照组。产后平均时间为 8.5 年（范围 1.1-20 年）。五项研究显示 pPE 女性的 CCA-IMT 明显高于健康对照组（占总数的 41.7%），而两组间 CCA-IMT 相似或 pPE 女性的 CCA-IMT 出人意料地低于对照组（占总数的 58.3%）。既往 LO-PE 女性（亚总 SMD 0.067，95%CI-0.339,0.472，P=0.75）和既往 EO-PE 女性（亚总 SMD 0.250，95%CI-0.231,0.732，P=0.31）的研究中，pPE 对 CCA-IMT 的影响非常小和小。总体而言，pPE 对 CCA-IMT 的影响较小且无统计学意义（SMD 0.143，95%CI-0.167,0.453，P=0.37）。纳入研究存在显著的异质性，总体 I 统计值为 81%（P<0.001）。Egger 检验回归截距的 P 值为 0.58，表明不存在发表偏倚。在荟萃回归分析中，没有一个调节因素和/或潜在混杂因素与效应修饰显著相关（均 P>0.05）。
既往有 PE 病史的女性存在心血管危险因素负担增加，但产后 20 年内似乎并未受到明显的亚临床颈动脉粥样硬化的影响。
