The preventive effects of different interventions on gestational hypertension: incidence and network meta-analysis

A network meta-analysis based on randomized controlled trials was conducted to investigate the effects of different interventions in preventing gestational hypertension (GHT).

A comprehensive search of English databases was performed from database inception to March 1st, 2025 to identify randomized controlled trials (RCTs) evaluating different interventions for the prevention GHT. The methodological quality and risk of bias for the included trials were appraised according to the Cochrane Handbook tool. A network meta-analysis was conducted using Stata version 15.1 software, and pooled effect estimates were expressed as the odds ratio (OR) with 95% confidence interval (CI).

A total of 50 randomized controlled trials involving 57,836 pregnant women were included in the network meta-analysis. For all included trials, 12 interventions were evaluated, resulting in 66 direct pairwise comparisons. The network meta-analysis demonstrated that compared with Placebo, Aspirin (OR = 0.68, 95% CI [0.48, 0.95]), Calcium (OR = 0.55, 95% CI [0.38, 0.80]), and the combination of Aspirin plus Calcium (OR = 0.12, 95% CI [0.03, 0.47]) were associated with a significantly reduced risk of gestational hypertension. Moreover, exercise (OR = 0.39, 95% CI [0.19, 0.82]) and aspirin plus calcium (OR = 0.12, 95% CI [0.03, 0.42]) were superior to usual-care in the prevention of GHT. Exercise includes yoga and walking. Ranking analysis based on the surface under the cumulative ranking curve (SUCRA) indicated that aspirin plus calcium had the highest probability of becoming the most effective intervention.

Maternal exercise (such as yoga and walking) or combined aspirin plus calcium supplementation might be promising interventions for the prevention of GHT. However, due to the limited number of available trials and the presence of potential heterogeneity, further large-scale, high-quality randomized controlled trials are warranted to validate these findings.