Oscillometric Postpartum Arterial Stiffness Measurements After Early-Onset Preeclamspia: A Comprehensive Quantitative Review

Preeclampsia (PE), a multi-system disorder, is not confined to the puerperium and may represent a sentinel event leading to increased maternal risk for future cardiovascular disease (CVD). Early-onset PE appears to carry a distinct, and possibly more pronounced, vascular signature than late-onset PE. Accumulating data consistently link previous early-onset PE, to an elevated lifetime risk of CVD. Arterial stiffness (AS), most commonly quantified by carotid-femoral pulse wave velocity (cf-PWV) and augmentation index (AIx, or AIx corrected to a heart rate of 75 beats per minute, AIx-75), is an established, independent predictor of CVD in the general population and has therefore attracted interest as a candidate marker for postpartum CVD risk stratification. However, whether AS remains elevated once the puerperium has resolved, has been a persistently unsettled question. Existing literature is inconclusive regarding the association between postpartum AS measurements and previous early-onset PE. This comprehensive review synthesizes the available literature on oscillometric AS measurements before and after delivery in pregnancies complicated by early-onset PE and attempts to quantify the differences between ante- and postpartum oscillometric AS measurements. Although not a systematic review, this quantitative review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-Analysis of Observational Studies in Epidemiology) guidelines. The study protocol was registered at PROSPERO (Prospective Register of Systematic Reviews System) (ID CRD42020167749) a priori. Only longitudinal studies reporting on both pregnancies complicated by early-onset PE (case group) and normotensive pregnancies (control group) were included. cf-PWV, Alx and Alx-75 were assessed both ante- and postpartum. Quantitative synthesis was performed for indices presented among at least 2 studies. Data were presented as standardized mean differences (SMDs) and 95% confidence intervals (95%CIs). Overall, from 14 citations of relevance, 3 studies with a total of 35 cases and 155 controls fulfilled the inclusion/exclusion criteria. In pregnancies complicated by early-onset PE assessed both ante- and postpartum with either cf-PWV (SMD: -0.61, 95%CI: -1.3 to 0.07) and/or Alx (SMD: -0.32, 95%CI: -2.83 to 2.2) and/or Alx-75 (SMD: -0.61, 95%CI: -1.27 to 0.05), there was no statistically significant difference in AS measurements. In conclusion, current literature suggests that AS measurements (cf-PWV, AIx and AIx-75) are not significantly altered in pregnancies complicated by early-onset PE. Alx and Alx-75 should be further evaluated. Substantial heterogeneity in study design, small sample sizes, and inconsistent postpartum follow-up windows continue to limit firm conclusions, underscoring the need for larger, standardized, and adequately powered longitudinal studies before AS measurements can be recommended for routine postpartum CVD risk stratification.