The effect of previous history of Pre-Eclampsia on subclinical carotid atherosclerosis up to 20 years Postpartum: A systematic review and Meta-Analysis

•The effect of pPE on CCA-IMT has been poorly investigated.•13 studies on CCA-IMT in pPE women were sistematically analyzed.•Average CCA-IMT was slightly, but significantly, increased in pPE women vs controls.•The overall effect of pPE on CCA-IMT was small and not statistically significant.•Intensive therapy, late-onset PE and short follow-up may explain these findings. During the last two decades, a few studies have evaluated the common carotid artery (CCA) intima-media thickness (IMT) in women with previous history of pre-eclampsia (pPE) in comparison to women with uncomplicated pregnancies, providing not univocal results. This systematic review and meta-analysis has been designed to summarize the main findings of these studies and to examine the overall influence of pPE on CCA-IMT. All studies assessing CCA-IMT in pPE women in comparison to women who had uncomplicated pregnancies, selected from PubMed and EMBASE databases, were included. Studies evaluating women with previous history of early-onset (EO) or late-onset (LO) PE vs healthy controls were separately analyzed. Continuous data (CCA-IMT) were pooled as a standardized mean difference (SMD) comparing pPE group with healthy controls. The subtotal and overall SMDs of CCA-IMT were calculated using the random-effect model. The full-texts of 12 studies with 583 pPE women and 610 healthy controls were analyzed. The average time after delivery was 8.5 yrs (range 1.1–20 yrs). The average CCA-IMT was significantly increased in pPE women than healthy controls in five studies (41.7 % of total), whereas it was similar between the two study groups or surprisingly reduced in pPE women vs controls in more than half of studies (58.3 % of total). The effect of pPE on CCA-IMT was very small for the studies including women with previous LO-PE (subtotal SMD 0.067, 95 %CI −0.339,0.472, P = 0.75) and small for those analyzing women with previous EO-PE (subtotal SMD 0.250, 95 %CI-0.231,0.732, P = 0.31). Overall, the effect of pPE on CCA-IMT was small and not statistically significant (SMD 0.143, 95 %CI −0.167,0.453, P = 0.37). Substantial heterogeneity was detected for the included studies, with an overall I2 statistic value of 81 % (P 0.05). Women with previous history o