Non-invasive vascular assessment in gestational hypertension and preeclampsia during pregnancy and the postpartum period: a systematic review

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. 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. 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. 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.