Pre-eclampsia primary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2]

Overview

Effective measures for the primary prevention of preeclampsia include administration of low dose aspirin (75-162 mg/day) before the 16th week of pregnancy and calcium supplement(1.2-2.5 g/day), especially in the high risk patients .

Primary prevention

Effective measures for the primary prevention of preeclampsia include administration of low dose aspirin (75-162 mg/day) before the 16th week of pregnancy and calcium supplement(1.2-2.5 g/day), especially in the high risk patients .^[1]^[2]^[3]
In a recent clinical trial, there was 62% reduction in the occurrence of preeclampsia in patients received 150 mg aspirin daily.
There is not strong evidence about the effectiveness of vitamin C, vitamin E , folic acid , sodium restriction for prevention of preeclampsia.^[4]^[5]
Low molecular weight heparin is not recommended for prevention of preeclampsia.

Indications of asprin prophylactic use in pregnancy

Risk level	Risk factors	Recommendation
High risk	*Previous preeclampsia Multifetal gestation Chronic hypertension Type 1 or 2 diabetes Renal disease Autoimmune disease (systemic lupus erythematosus, antiphospholipid syndrome)	Starting low dose of asprin if the patient has one or more of these risk factors
Moderate	Nulliparity Obesity (body mass index > 30) Family history of preeclampsia (mother or sister) Sociodemographic characteristics (African American race, low socioeconomic status) Age≥ 35 years old Previous history factors of: low birth weight small for gestational age Previous adverse pregnancy outcome More than 10-year pregnancy interval	Starting low-dose aspirin if the patient has two or more of these moderate-risk factors
Low risk	Previous uncomplicated full term delivery	NO recommended aspirin

References

↑ Hofmeyr, G Justus; Lawrie, Theresa A; Atallah, Álvaro N; Torloni, Maria Regina (2018). “Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems”. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD001059.pub5. ISSN 1465-1858.
↑ Rolnik, Daniel L.; Wright, David; Poon, Liona C.; O’Gorman, Neil; Syngelaki, Argyro; de Paco Matallana, Catalina; Akolekar, Ranjit; Cicero, Simona; Janga, Deepa; Singh, Mandeep; Molina, Francisca S.; Persico, Nicola; Jani, Jacques C.; Plasencia, Walter; Papaioannou, George; Tenenbau Gavish, Kinneret; Meiri, Hamutal; Gizurarson, Sveinbjorn; Maclagan, Kate; Nicolaides, Kypros H. (2017). “Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia”. New England Journal of Medicine. 377 (7): 613–622. doi:10.1056/NEJMoa1704559. ISSN 0028-4793.
↑ Mayrink, J.; Costa, M. L.; Cecatti, J. G. (2018). “Preeclampsia in 2018: Revisiting Concepts, Physiopathology, and Prediction”. The Scientific World Journal. 2018: 1–9. doi:10.1155/2018/6268276. ISSN 2356-6140.
↑ Rumbold A, Duley L, Crowther CA, Haslam RR (January 2008). “Antioxidants for preventing pre-eclampsia”. Cochrane Database Syst Rev (1): CD004227. doi:10.1002/14651858.CD004227.pub3. PMC 6718237 Check |pmc= value (help). PMID 18254042.
↑ Ostadrahimi, Alireza; Mohammad-Alizadeh, Sakineh; Mirgafourvand, Mozhgan; Yaghoubi, Sina; Shahrisa, Elham; Farshbaf-Khalili, Azizeh (2016). “Effects of Fish Oil Supplementation on Gestational Diabetes Mellitus (GDM): A Systematic Review”. Iranian Red Crescent Medical Journal. 18 (11). doi:10.5812/ircmj.24690. ISSN 2074-1804.
↑ . doi:10.1097/AOG.0000000000003891. Check |doi= value (help). Missing or empty |title= (help)

[HofmeyrLawrie2018-1] Hofmeyr, G Justus; Lawrie, Theresa A; Atallah, Álvaro N; Torloni, Maria Regina (2018). “Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems”. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD001059.pub5. ISSN 1465-1858.

[RolnikWright2017-2] Rolnik, Daniel L.; Wright, David; Poon, Liona C.; O’Gorman, Neil; Syngelaki, Argyro; de Paco Matallana, Catalina; Akolekar, Ranjit; Cicero, Simona; Janga, Deepa; Singh, Mandeep; Molina, Francisca S.; Persico, Nicola; Jani, Jacques C.; Plasencia, Walter; Papaioannou, George; Tenenbau Gavish, Kinneret; Meiri, Hamutal; Gizurarson, Sveinbjorn; Maclagan, Kate; Nicolaides, Kypros H. (2017). “Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia”. New England Journal of Medicine. 377 (7): 613–622. doi:10.1056/NEJMoa1704559. ISSN 0028-4793.

[MayrinkCosta2018-3] Mayrink, J.; Costa, M. L.; Cecatti, J. G. (2018). “Preeclampsia in 2018: Revisiting Concepts, Physiopathology, and Prediction”. The Scientific World Journal. 2018: 1–9. doi:10.1155/2018/6268276. ISSN 2356-6140.

[pmid18254042-4] Rumbold A, Duley L, Crowther CA, Haslam RR (January 2008). “Antioxidants for preventing pre-eclampsia”. Cochrane Database Syst Rev (1): CD004227. doi:10.1002/14651858.CD004227.pub3. PMC 6718237 Check |pmc= value (help). PMID 18254042.

[OstadrahimiMohammad-Alizadeh2016-5] Ostadrahimi, Alireza; Mohammad-Alizadeh, Sakineh; Mirgafourvand, Mozhgan; Yaghoubi, Sina; Shahrisa, Elham; Farshbaf-Khalili, Azizeh (2016). “Effects of Fish Oil Supplementation on Gestational Diabetes Mellitus (GDM): A Systematic Review”. Iranian Red Crescent Medical Journal. 18 (11). doi:10.5812/ircmj.24690. ISSN 2074-1804.

[6] . doi:10.1097/AOG.0000000000003891. Check |doi= value (help). Missing or empty |title= (help)

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