LAUSR

Preeclampsia (PE) is a common pregnancy disease, linked with several complications during and after pregnancy. Although its pathogenesis is not completely understood, evidence suggests that PE has long-term health effects of both the mother and the offspring. An umbrella review was performed to identify systematic reviews and meta-analyses on the association of PE with long-term health outcomes in women and infants born to pregnancies complicated with PE. We searched PubMed, EMBASE, Scopus and ISI Web of Science from inception to March 2019. For each meta-analysis we estimated the summary effect size by random-effects and fixed-effects models, the 95% confidence interval, the 95% prediction interval (PI), the between-study heterogeneity, evidence of small-study effects and evidence of excess significance bias. To evaluate the credibility of the published evidence we preferred state-of-the-art approaches of predefined criteria. Twenty-two eligible meta-analyses were identified providing data on 71 associations. Forty-nine (69%) associations had nominally statistically significant findings at P < 0.05, while nineteen (27%) remain significant at P < 10-6 under the random-effects model. Forty (56%) associations had large or very large heterogeneity. Evidence for small-study effects and excess significance bias was found in 4 (6%) and 7 (10%) associations, respectively. Only five associations presented robust evidence: cerebrovascular disease (cohort studies), cerebrovascular disease (overall), cardiac disease, cardiovascular mortality and attention deficit hyperactivity disorder (ADHD). These were supported by > 1000 cases, 95% PI excluding the null, no large heterogeneity, small-study effects, or excess of significance. Our findings suggest an increased risk for women to develop cerebrovascular, cardiovascular and cardiac diseases after a pregnancy complicated by PE, while offspring exposed to PE are at higher risk for ADHD. Our findings highlight the importance of promoting ongoing patient assessment practices for prevention and early diagnosis of these comorbidities. More research is required for the elevated risks of the reported outcomes to improve maternal health.