Prevention of Preeclampsia: Is it Still a Disappointment?

Abstract

Preeclampsia is a major cause of maternal mortality worldwide, with many preventive strategies tested. In this review we intend to provide a synthesis of available studies of these strategies that have been tested, including systematic reviews. We will not be performing systematic review of the studies here. Of these strategies tested only low dose acetyl salicylic acid (ASA) and calcium can be considered helpful for prevention at this time. A recent meta-analysis showed a benefi t of low dose ASA for both high (RR 0.75, 95% CI 0.66 to 0.85) and moderate risk groups (RR 0.86, 95% CI 0.79 to 0.95). Therefore, low dose ASA in high risk groups may be useful, with a possible smaller benefi t in moderate to low risk women. Another meta-analysis looking at calcium shows benefi t for both high and low risk groups with an overall reduction in the risk of preeclampsia (RR 0.48, 95% CI 0.33 to 0.69). As a result, prenatal supplementation of calcium may be benefi cial for the prevention of preeclampsia. However, vitamins C and E, zinc, fi sh oil, and magnesium supplementation have been discounted as potential preventive strategies. Nitric oxide, folic acid, and antithrombotics have not been well studied and there is insuffi cient data for reliable conclusions to be made. Areas of ongoing research that appear promising in the prevention of preeclampsia include modifi able metabolic factors, angiogenic proteins, angiotensin receptor antibodies, and syncytiotrophoblast microparticles. Strategies targeting these areas may provide opportunities for therapeutic interventions.

Effects of Maternal Nutritional Supplements and Dietary Interventions on Placental Complications: An Umbrella Review, Meta-Analysis and Evidence Map

“…In total, 124 records were excluded at full-text review, including a mismatch in populations in a single study (i.e., supplementing infants), three in intervention (dietary interventions not reported separately), three in comparator (compared dosages, thus supplement given to both intervention and control), 12, which did not report outcomes of interest (i.e., infant mortality), 19 in study design (i.e., observational studies, commentary) and 48 duplicates and older versions of Cochrane reviews ( Table S3 ). Nineteen umbrella reviews [ 10 , 11 , 12 , 13 , 14 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ] were excluded and 19 reviews that did not report meta-analyses of RCTs (narrative syntheses only, meta-analysis of observational studies or combined observational and RCTs) (vitamin A [ 35 , 36 , 37 ], vitamin B6 and/or 12 [ 35 , 38 ], vitamin C and/or E [ 35 , 38 , 39 ], vitamin D and/or calcium [ 35 , 37 , 40 , 41 , 42 ], iron and/or folic acid [ 35 , 37 , 41 , 43 , 44 ], magnesium [ 35 , 37 ], zinc [ 45 , 46 , 47 ], MMN […”

Association of pre-eclampsia risk with maternal levels of folate, homocysteine and vitamin B12 in Colombia: A case-control study

“…Pre-eclampsia is defined as the development of hypertension and proteinuria after the 20th week of gestation in normotensive women [1], and is considered one of the major causes of maternal and neonatal morbidity and mortality in low and middle-income countries [2–3]. Although the aetiology of this disorder is poorly understood, a great amount of effort has been made to identify potential causal risk factors toward preventing the development of pre-eclampsia [4–7]; nevertheless, they have not yet been translated into largely effective interventions [8–10].…”

Blood urea nitrogen/creatinine index is a predictor of prerenal damage in preeclampsia

“…As a consequence of the increase of BUN and the decrease of albumins, there exists a regressive correlation between BUN/Creatinine and A/G index at the preecplamptic group (Table 2). Also, in the preeclamptic group there was a significant decrease of platelets (Table 1) as a result of the increased rate of coagulability in this group ( 8,(21)(22)25).…”