Key result
Non-invasive vascular testing reveals persistent arterial stiffness and endothelial dysfunction up to 6 years postpartum.
Why the study?
This review aimed to evaluate evidence on non-invasive vascular assessment techniques during pregnancy and the postpartum period for identifying vascular abnormalities in gestational hypertension and exploring implications for long-term cardiovascular health.
Do non-invasive vascular assessment techniques identify vascular abnormalities in women with gestational hypertension and preeclampsia during pregnancy and the postpartum period?
Systematic Review (n=32,683)
Do non-invasive vascular assessment techniques identify vascular abnormalities in women with gestational hypertension and preeclampsia during pregnancy and the postpartum period?
Non-invasive vascular assessments identify macrovascular, microvascular, and endothelial abnormalities in women with gestational hypertension and preeclampsia during and after pregnancy, though standardized longitudinal studies are needed before they can be used to predict future cardiovascular events.
Answers are grounded in this paper and cite their sources.
Persistent vascular changes after gestational hypertension warrant monitoring caution; leaves open their predictive value for events.
OBJECTIVE: To evaluate evidence on non-invasive vascular assessment techniques used during pregnancy and/or the postpartum period to identify vascular abnormalities associated with gestational hypertension and explore potential implications for long-term cardiovascular health. METHODS: A systematic search of MEDLINE, PubMed, Scopus, the Cochrane Library, and gray literature (to May-2024) identified studies assessing vascular structure or function using pulse-wave velocity, carotid intima-media thickness, flow-mediated dilation, ophthalmic artery Doppler, and retinal imaging. Forty-nine studies involving 32,683 participants. Due to the heterogeneity in study design and methodology, findings were synthesized narratively. RESULTS: Women with gestational hypertension generally demonstrated increased arterial stiffness (elevated pulse wave velocity and augmentation index), impaired endothelial function (reduced flow-mediated dilation), and increased intima-media thickness during pregnancy and the postpartum period. Several studies reported persistence of these abnormalities from weeks to years after delivery, although findings were inconsistent. Ophthalmic artery Doppler studies showed variable alterations in peak systolic velocity ratios and pulsatility index reported in hypertensive pregnancies. Retinal imaging identified alterations in retinal vessel caliber during pregnancy and the postpartum period, with some abnormalities reported up to six years postpartum. CONCLUSION: Non-invasive vascular assessments can help identify macrovascular, microvascular, and endothelial abnormalities in women with gestational hypertension and preeclampsia during pregnancy and the postpartum period. Although some abnormalities persist beyond delivery and may contribute to long-term cardiovascular risk, evidence remains insufficient to support their use as independent predictors of future cardiovascular events. Further standardized, prospective longitudinal studies are needed to determine their prognostic and clinical value.
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Alkhurainej et al. (2026) conducted a systematic review in Gestational hypertension and preeclampsia during pregnancy and the postpartum period (n=32,683). Non-invasive vascular assessment techniques (pulse-wave velocity, carotid intima-media thickness, flow-mediated dilation, ophthalmic artery Doppler, retinal imaging) was evaluated on Vascular structure and function abnormalities (arterial stiffness, endothelial function, intima-media thickness, ophthalmic artery Doppler indices, retinal vessel caliber). Non-invasive vascular assessments across 49 studies (n=32,683) identified increased arterial stiffness, impaired endothelial function, and increased intima-media thickness up to 6 years postpartum.
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