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Prevention of preeclampsia: a big disappointment
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Universityof Tennessee, Memphis, TN, USA.
Abstract:
Preeclampsia is a multisystem disorder of unknown etiology. During the past 2 decades, numerous clinical reports and randomized trials described the use of various methods to prevent or reduce the incidence and severity of preeclampsia. These methods were used in an attempt to correct certain abnormalities such as biochemical imbalance, a pathophysiologic mechanism, or a dietary deficiency. There are at least 15 randomized trials evaluating the use of various antihypertensive drugs including diuretics for the prevention of preeclampsia. Results of these trials reveal no such benefit. There are few randomized trials evaluating magnesium (n = 2), zinc (n = 2), or fish oil supplementation (n = 3) to prevent preeclampsia. The majority of these trials had limited sample size; however, results reveal minimal-to-no benefit. There are 7 placebo-controlled trials evaluating calcium supplementation during pregnancy. Findings of these trials reveal that calcium supplementation does not reduce the incidence of preeclampsia in healthy nulliparous women. The majority of randomized trials for the prevention of preeclampsia have used low-dose aspirin. Results of early single-center trials demonstrated an average reduction of preeclampsia of 70% with low-dose aspirin. However, results of recent large multicenter trials (n = 7) that included >27,000 women revealed minimal-to-no benefit. Until the pathogenesis of preeclampsia is well defined, prevention of this syndrome with any modality remains unlikely.
Insights
Preventing preeclampsia remains unlikely as numerous trials show minimal benefit from interventions like antihypertensives, supplements, and aspirin. Further research into the causes of preeclampsia is needed for effective prevention strategies.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Clinical Pharmacology
Background:
- Preeclampsia is a serious multisystem disorder with an unknown cause.
- Numerous interventions have been explored to prevent or reduce preeclampsia incidence and severity.
- Previous research focused on correcting biochemical imbalances, pathophysiological mechanisms, or dietary deficiencies.
Purpose of the Study:
- To review and analyze the efficacy of various interventions for preeclampsia prevention.
- To assess the impact of antihypertensive drugs, nutritional supplements, and low-dose aspirin on preeclampsia.
- To determine if current methods can effectively prevent preeclampsia.
Main Methods:
- Systematic review of randomized controlled trials and placebo-controlled trials.
- Analysis of data from trials evaluating antihypertensive drugs, magnesium, zinc, fish oil, calcium, and low-dose aspirin.
- Inclusion of early single-center trials and recent large multicenter trials.
Main Results:
- Antihypertensive drugs and diuretics showed no benefit in preventing preeclampsia.
- Magnesium, zinc, and fish oil supplementation had minimal-to-no benefit, with limited sample sizes.
- Calcium supplementation did not reduce preeclampsia incidence in healthy nulliparous women.
- Low-dose aspirin showed significant reduction in early trials, but large multicenter trials revealed minimal-to-no benefit.
Conclusions:
- Current prevention strategies, including medications and supplements, have demonstrated minimal to no significant benefit in preventing preeclampsia.
- The lack of efficacy suggests that a deeper understanding of preeclampsia's underlying pathogenesis is crucial.
- Effective prevention of preeclampsia is unlikely until its etiology is better understood.