Physical exercise and metformin in the prevention of pre-eclampsia: systematic review

Abstract

Introduction: Pre-eclampsia is a disorder that may occur during pregnancy but is still unknown and / or multifactorial causes. Objective: To verify whether physical exercise and metformin may be helpful in preventing preeclampsia. Method: This is a systematic review of the literature in PubMed / MEDLINE, Web of Science, Scopus, LILACS and Cochrane. This review followed the critiques of the PRISMA checklist. Bias assessment was used for the Cochrane Handbook for Systematical Reviews of Interventions (Version 5.1.0) for clinical trials and the Downs and Black scale for cohort and case-control studies. Results: 17 studies were within the established criteria. The subjects evaluated were: pre-eclampsia, cardiovascular metabolic factors, physiotherapeutic therapies and the effects of physical exercise and metformin on the circulatory system. Conclusion: There is a need for adapted techniques and new protocols according to the contingencies and complications of pregnancy. During pregnancy, it is suggested a greater interdisciplinarity of knowledge among professionals and that the therapy receives adjustments against the metabolic alterations of the reproductive system. In order to prevent preeclampsia, the study suggests a program of individual exercises that include greater assistance, verification and / or comprehension of possible changes and their limits during pregnancy. As well as, the adjuvant use of metformin of 1000 mg/d in the initial phase, with the purpose of maintaining the effects of the drug due to renal clearance during pregnancy, until reaching a maximum of 1500 mg/d, to avoid side effects of the drug.

Síndromes hipertensivas gestacionais: impacto da pré-eclâmpsia na saúde das gestantes

“…O tratamento da pré-eclâmpsia consiste, muitas vezes, na necessidade de hospitalização da gestante, podendo ser utilizados medicamentos anti-hipertensivos, corticoides e antiepilépticos (sulfato de magnésio), desde que compatíveis com o quadro gestacional (Nascimento et al, 2020). A pravastatina pode ser indicada, com fortes evidências científicas, como opção terapêutica para o tratamento das formas iniciais ou graves (Moura et al, 2020).…”

“…O tratamento preventivo geral contra pré-eclâmpsia se deve a prática de exercícios físicos com assistência profissional para a delimitação das atividades de acordo com as limitações existentes com o progresso da gestação e verificação de possíveis alterações nesse período (Nascimento et al, 2020). Já gestantes com alto risco de desenvolver pré-eclâmpsia pode-se considerar, avaliando individualmente os quadros clínicos, o uso de medicações como a heparina, aspirina combinada com cálcio ou dipiridamol, pois estes medicamentos auxiliam a cascata de coagulação, agregação plaquetária e disfunção endotelial (Moura et al, 2020).…”