23 Fetal programming: A systematic review of medium and long term health outcomes after intrauterine exposure to maternal hypertensive disorders during pregnancy

Introduction The hypertensive disorders of pregnancy are a leading cause of morbidity and mortality for mother and offspring, and complicate up to 10% of pregnancies over the world. Objectives The aim was to systematically review evidence of offspring’s medium and long term health outcomes after intrauterine exposure to maternal hypertension during pregnancy. Methods A research on PubMed/MEDLINE and Bireme databases were conducted to identify observational studies that reported evidence about any offspring outcome measured after the 6th month of life. Two authors independently and blindly reviewed the titles, abstracts and full papers, selecting those that meet all inclusion criteria. For each step, a third reviewer was requested to decide disagreements. Results A total of 45 were included in the review and the outcomes were categorized into four groups: cardiovascular, immune, metabolic and behavioral/neurological effects. According to our findings, hypertensive disorders of pregnancy had an overall negative effect on offspring’s cardiovascular, immune and neurological health. The most prominent and reliable associations were verified between preeclampsia and offspring’s lower cognitive functioning and between gestational hypertension and higher offspring’s blood pressure. Among the metabolic outcomes, body composition had conflicting results, while all studies that examined blood biomarkers showed no evidence of alteration after preeclampsia or gestational hypertension exposure. Most included studies were highly heterogeneous regarding the measure of outcomes and covariables used for adjustments. Conclusions Our findings suggest that further researches are necessary to overcome the heterogeneity of the studies about maternal hypertension disorders during pregnancy and to reveal the mechanisms involved in the observed associations. Future studies should consider using the same protocols and cut-off points already published so that results can be better compared and summarized.