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DOI: 10.1055/s-0040-1714135
Clinical Procedures for the Prevention of Preeclampsia in Pregnant Women: A Systematic Review
Procedimentos clínicos para a prevenção de pré-eclâmpsia em gestantes: Uma revisão sistemáticaAbstract
Objective To identify the most effective procedures recommended for the prevention of preeclampsia.
Data Sources A systematic review was performed in the following databases: Pubmed/MEDLINE, CINAHL, Web of Science, Cochrane and LILACS via the Virtual Health Library (VHL). A manual search was also performed to find additional references. The risk of bias, the quality of the evidence, and the classification of the strength of the recommendations were evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.
Selection of Studies In the initial search in the databases, the total number of articles retrieved was 351, and 2 were retrieved through the manual search; after duplicate articles were removed, 333 citations remained. After a thorough review of the titles and abstracts, 315 references were excluded. Accordingly, 18 articles were maintained for selection of the complete text (phase 2). This process led to the exclusion of 6 studies. In total, 12 articles were selected for data extraction and qualitative synthesis.
Data Collection The articles selected for the study were analyzed, and we inserted the synthesis of the evidence in the online software GRADEpro Guideline Development Tool (GDT) (McMaster University and Evidence Prime Inc. All right reserved. McMaster University, Hamilton, Ontário, Canada); thus, it was possible to develop a table of evidence, with the quality of the evidence and the classification of the strength of the recommendations.
Data Synthesis In total, seven studies recommended the individual use of aspirin, or aspirin combined with calcium, heparin or dipyridamole. The use of calcium alone or in combination with phytonutrients was also highlighted. All of the studies were with women at a high risk of developing preeclampsia.
Conclusion According to the studies evaluated, the administration of aspirin is still the best procedure to be used in the clinical practice to prevent preeclampsia.
Resumo
Objetivo Identificar quais são as condutas recomendadas para a prevenção de pré-eclâmpsia em gestantes.
Fontes de Dados Foi feita uma revisão sistemática da literatura, e foram desenvolvidas estratégias detalhadas de busca individual nas bases de dados PubMed/MEDLINE, CINAHL, Web of Science, Cochrane e LILACS pela Biblioteca Virtual em Saúde (BVS). Uma pesquisa manual também foi realizada para encontrar referências adicionais. O risco de viés, a qualidade da evidência, e a classificação da força das recomendações foram avaliadas usando a abordagem Classificação de Recomendações, Avaliação, Desenvolvimento e Análises (Gradings of Recommendations, Assessment, Development and Evaluations, GRADE).
Seleção dos Estudos No total, foram encontrados 351 artigos na busca inicial nas bases de dados consultadas e 2 na busca manual; após exclusões por duplicidade, 333 artigos permaneceram. Após a leitura de títulos e resumos, 315 referências foram excluídas. Portanto, 18 artigos foram mantidos para a seleção do texto completo (fase 2); esse processo levou à exclusão de 6 artigos. Após as exclusões por incompatibilidade com os critérios de inclusão, 12 artigos compuseram a amostra.
Coleta de Dados Os artigos selecionados para o estudo foram analisados, e a digitação da síntese das evidências foi realizada no software online GRADEpro Guideline Development Tool (GDT) (McMaster University and Evidence Prime Inc. Todos os direitos reservados. McMaster University, Hamilton, Ontário, Canadá), o que possibilitou a elaboração de uma tabela de evidências, com a qualidade das evidências e a classificação da força das recomendações.
Síntese dos Dados No total, sete estudos recomendaram o uso individual de aspirina, ou aspirina combinada com cálcio, heparina ou dipiridamol. O uso de cálcio isolado ou em combinação com fitonutrientes também foi destacado. Todos os estudos foram realizados com mulheres com alto risco de desenvolver pré-eclâmpsia.
Conclusão De acordo com os estudos avaliados, a administração de aspirina ainda é a melhor conduta a ser utilizada na prática clínica para prevenir a pré-eclâmpsia.
Keywords
pregnant women - preeclampsia - prevention and control - maternal health - pregnancy complicationsPalavras-chave
gestante - pré-eclâmpsia - prevenção e controle - saúde materna - complicações na gravidezPublikationsverlauf
Eingereicht: 03. Mai 2020
Angenommen: 03. Juni 2020
Artikel online veröffentlicht:
31. Oktober 2020
© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
Thieme Revinter Publicações Ltda
Rio de Janeiro, Brazil
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References
- 1 Torjusen H, Brantsæter AL, Haugen M, Alexander J, Bakketeig LS, Lieblein G. et al. Reduced risk of pre-eclampsia with organic vegetable consumption: results from the prospective Norwegian Mother and Child Cohort Study. BMJ Open 2014; 4 (09) e006143 DOI: 10.1136/bmjopen-2014-006143.
- 2 Lee SM, Moon JY, Lim BY, Kim SM, Park CW, Kim BJ. et al. Increased biosynthesis and accumulation of cholesterol in maternal plasma, but not amniotic fluid in pre-eclampsia. Sci Rep 2019; 9 (01) 1550 DOI: 10.1038/s41598-018-37757-3.
- 3 Costantine MM, Cleary K, Hebert MF, Ahmed MS, Brown LM, Ren Z. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Obstetric-Fetal Pharmacology Research Units Network. Safety and pharmacokinetics of pravastatin used for the prevention of preeclampsia in high-risk pregnant women: a pilot randomized controlled trial. Am J Obstet Gynecol 2016; 214 (06) 720.e1-720.e17 DOI: 10.1016/j.ajog.2015.12.038.
- 4 Say L, Chou D, Gemmill A, Tunçalp O, Moller AB, Daniels J. et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2 (06) e323-e333 DOI: 10.1016/S2214-109X(14)70227-X.
- 5 Rolnik DL, Wright D, Poon LC, O'Gorman N, Syngelaki A, Matallana CP. et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med 2017; 377 (07) 613-622 DOI: 10.1056/NEJMoa1704559.
- 6 Erez O, Romero R, Maymon E, Chaemsaithong P, Done B, Pacora P. et al. The prediction of late-onset preeclampsia: Results from a longitudinal proteomics study. PLoS One 2017; 12 (07) e0181468 DOI: 10.1371/journal.pone.0181468.
- 7 Guida JPS, Surita FG, Parpinelli MA, Costa ML. Preterm preeclampsia and timing of delivery: a systematic literature review. Rev Bras Ginecol Obstet 2017; 39 (11) 622-631 DOI: 10.1055/s-0037-1604103.
- 8 Stevens W, Shih T, Incerti D, Ton TGN, Lee HC, Peneva D. et al. Short-term costs of preeclampsia to the United States health care system. Am J Obstet Gynecol 2017; 217 (03) 237-248.e16 DOI: 10.1016/j.ajog.2017.04.032.
- 9 Talari H, Mesdaghinia E, Abedzadeh Kalahroudi M. Aspirin and preeclampsia prevention in patients with abnormal uterine artery blood flow. Iran Red Crescent Med J 2014; 16 (08) e17175 DOI: 10.5812/ircmj.17175.
- 10 Camarena Pulido EE, García Benavides L, Panduro Barón JG, Pascoe Gonzalez S, Madrigal Saray AJ, García Padilla FE. et al. Efficacy of L-arginine for preventing preeclampsia in high-risk pregnancies: A double-blind, randomized, clinical trial. Hypertens Pregnancy 2016; 35 (02) 217-225 DOI: 10.3109/10641955.2015.1137586.
- 11 Rocha RS, Alves JAG, Maia E Holanda Moura SB, Araujo Júnior E, Peixoto AB, Santana EFM. et al. Simple approach based on maternal characteristics and mean arterial pressure for the prediction of preeclampsia in the first trimester of pregnancy. J Perinat Med 2017; 45 (07) 843-849 DOI: 10.1515/jpm-2016-0418.
- 12 O'Gorman N, Wright D, Syngelaki A, Akolekar R, Wright A, Poon LC. et al. Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11-13 weeks gestation. Am J Obstet Gynecol 2016; 214 (01) 103.e1-103.e12 DOI: 10.1016/j.ajog.2015.08.034.
- 13 Hofmeyr GJ, Belizán JM, von Dadelszen P. Calcium and Pre-eclampsia (CAP) Study Group. Low-dose calcium supplementation for preventing pre-eclampsia: a systematic review and commentary. BJOG 2014; 121 (08) 951-957 DOI: 10.1111/1471-0528.12613.
- 14 Souza EV, Torloni MR, Atallah AN, Santos GMS, Kulay Jr L, Sass N. Aspirin plus calcium supplementation to prevent superimposed preeclampsia: a randomized trial. Braz J Med Biol Res 2014; 47 (05) 419-425 DOI: 10.1590/1414-431X20143629.
- 15 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097 DOI: 10.1371/journal.pmed.1000097.
- 16 Schünemann H, Brożek J, Guyatt G, Oxman A. Handbook for grading quality of evidence and strength of recommendations using the GRADE approach [Internet]. 2013 [cited 2018 Dec 10]. Available from: https://gdt.gradepro.org/app/handbook/handbook.html
- 17 World Health Organization. WHO recommendations for prevention and treatment of preeclampsia and eclampsia [Internet]. Geneva: WHO; 2011. [cited 2018 Dec 10]. Available from: https://apps.who.int/iris/bitstream/handle/10665/44703/9789241548335_eng.pdf?sequence=1
- 18 ACOG Practice Bulletin No. 203: chronic hypertension in pregnancy. Obstet Gynecol 2019; 133 (01) e26-e50 DOI: 10.1097/AOG.0000000000003020.
- 19 Roberge S, Nicolaides K, Demers S, Hyett J, Chaillet N, Bujold E. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol 2017; 216 (02) 110-120.e6 DOI: 10.1016/j.ajog.2016.09.076.
- 20 Roberge S, Demers S, Nicolaides KH, Bureau M, Côté S, Bujold E. Prevention of pre-eclampsia by low-molecular-weight heparin in addition to aspirin: a meta-analysis. Ultrasound Obstet Gynecol 2016; 47 (05) 548-553 DOI: 10.1002/uog.15789.
- 21 Gan J, He H, Qi H. Preventing preeclampsia and its fetal complications with low-dose aspirin in East Asians and non-East Asians:A systematic review and meta-analysis. Hypertens Pregnancy 2016; 35 (03) 426-435 DOI: 10.1080/10641955.2016.1178772.
- 22 Tong S, Mol BW, Walker SP. Preventing preeclampsia with aspirin: does dose or timing matter?. Am J Obstet Gynecol 2017; 216 (02) 95-97 DOI: 10.1016/j.ajog.2016.12.003.
- 23 Panagodage S, Yong HEJ, Da Silva Costa F, Borg AJ, Kalionis B, Brennecke SP. et al. Low-dose acetylsalicylic acid treatment modulates the production of cytokines and improves trophoblast function in an in vitro model of early-onset preeclampsia. Am J Pathol 2016; 186 (12) 3217-3224 DOI: 10.1016/j.ajpath.2016.08.010.
- 24 von Dadelszen P, Magee LA. Preventing deaths due to the hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 36: 83-102 DOI: 10.1016/j.bpobgyn.2016.05.005.
- 25 Roberge S, Bujold E, Nicolaides KH. Aspirin for the prevention of preterm and term preeclampsia: systematic review and metaanalysis. Am J Obstet Gynecol 2018; 218 (03) 287-293.e1 DOI: 10.1016/j.ajog.2017.11.561.
- 26 Rodger MA, Carrier M, Le Gal G, Martinelli I, Perna A, Rey E. et al; Low-Molecular-Weight Heparin for Placenta-Mediated Pregnancy Complications Study Group. Meta-analysis of low-molecular-weight heparin to prevent recurrent placenta-mediated pregnancy complications. Blood 2014; 123 (06) 822-828 DOI: 10.1182/blood-2013-01-478958.
- 27 Parrish MR, Martin Jr JN, Lamarca BB, Ellis B, Parrish SA, Owens MY. et al. Randomized, placebo controlled, double blind trial evaluating early pregnancy phytonutrient supplementation in the prevention of preeclampsia. J Perinatol 2013; 33 (08) 593-599 DOI: 10.1038/jp.2013.18.
- 28 Lassi ZS, Mansoor T, Salam RA, Das JK, Bhutta ZA. Essential pre-pregnancy and pregnancy interventions for improved maternal, newborn and child health. Reprod Health 2014; 11 (Suppl. 01) S2 DOI: 10.1186/1742-4755-11-S1-S2.
- 29 Esteve-Valverde E, Ferrer-Oliveras R, Gil-Aliberas N, Baraldès-Farré A, Llurba E, Alijotas-Reig J. Pravastatin for preventing and treating preeclampsia: a systematic review. Obstet Gynecol Surv 2018; 73 (01) 40-55 DOI: 10.1097/OGX.0000000000000522.
- 30 Costantine MM, Ananth CV. The early developments of preeclampsia drugs. Expert Opin Investig Drugs 2016; 25 (08) 867-870 DOI: 10.1080/13543784.2016.1196185.