Comparative effectiveness of prophylactic strategies for preeclampsia: a network meta-analysis of randomized controlled trials

Liu, Yuanhui; Zhang, Ye-shen; Chen, Jia-yi; Wang, Zhijian; Liu, Yao-xin; Li, Jiaqi; Xu, Xizhan; Xie, Nianjin; Lye, Stephen J.; Tan, Ning; Duan, Chongyang; Wei, Yan-xing; He, Pengcheng

doi:10.1016/j.ajog.2022.10.014

Cited by 16 publications

(3 citation statements)

References 40 publications

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“…However, it did not compare the effect of LMWH separately from LDA. Some studies have explored the effect of LMWH on PE based on aspirin and found that treatment with LMWH and aspirin, compared with aspirin alone, was associated with a significant reduction in PE [25][26][27], while some of them have found that treatment with LMWH has no significant benefit in preventing PE [28].…”

Section: Comparison Of Results With Those Of Previous Studiesmentioning

confidence: 99%

Low-molecular-weight heparin for the prevention of preeclampsia in high-risk pregnancies without thrombophilia: a systematic review and meta-analysis

Chen,

Huai,

Yang

2024

BMC Pregnancy Childbirth

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Objectives To systematically evaluate the efficacy of low molecular weight heparin (LMWH) to prevent preeclampsia in high risk pregnant women without thrombophilia. Search strategy PubMed, Embase and the Cochrane library were searched for articles published before 1st August 2022 using the combination keywords “preeclampsia”, “Low Molecular Weight Heparin”, “LMWH”, “Heparin, Low Molecular Weight”, “Dalteparin”, “Nadroparin”, and “Tinzaparin”. Selection criteria: Randomized controlled trials evaluating the use of LMWH in pregnant women at high risk of preeclampsia without thrombophilia. Data collection and analysis Ten studies were included in the meta-analysis (1758 patients in total). Outcomes were expressed as relative risk (RR) with 95% confidence intervals (CI). Results LMWH reduced the incidence of PE (RR = 0.67; 95% CI = 0.50–0.90; P = 0.009) in high risk pregnant women without thrombophilia. Subgroup analysis found that the prophylactic effect of LMWH was only significant in studies using low-dose aspirin (LDA) as the primary intervention. The combination of LMWH and LDA was also effective for the prevention of preterm birth and fetal growth restriction, but had no effect on the incidence of placenta abruption. Conclusion For women at high risk of developing preeclampsia without thrombophilia, the combination of LMWH and low-dose aspirin is effective for the prevention of preeclampsia, preterm birth and fetal growth restriction and is superior to LDA alone.

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Section: Comparison Of Results With Those Of Previous Studiesmentioning

confidence: 99%

Low-molecular-weight heparin for the prevention of preeclampsia in high-risk pregnancies without thrombophilia: a systematic review and meta-analysis

Chen,

Huai,

Yang

2024

BMC Pregnancy Childbirth

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“…It is important to highlight a meta-analysis from 2018 that found, based on more than 100 clinical trials and more than 250,000 patients’ data, that exercise-only interventions lower the risk of many pregnancy-related adverse outcomes, including preeclampsia ( n = 3322, OR of 0.59, 95% CI of 0.37 to 0.9), compared to the data of patients who performed no exercise during their respective pregnancies [ 105 ]. A 2023 meta-analysis carried out by Liu et al also found that exercise during pregnancy lowers the risk of preeclampsia [ 106 ]. As per the 2021 meta-analysis conducted by Magro-Malosso et al, engaging in aerobic exercise sessions lasting around 30 to 60 min occurring two to seven times per week throughout pregnancy has shown a link to a notable decrease in the overall risk of gestational hypertensive disorders.…”

Section: New Approaches To the Pregnancy Lifestylementioning

confidence: 99%

Recent Advances in the Prevention and Screening of Preeclampsia

Mészáros,

Kukor,

Valent

2023

JCM

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Throughout the history of medicine, preeclampsia has remained an enigmatic field of obstetrics. In 2023, despite its prevalence and impact, preeclampsia’s exact cause and effective treatment remain elusive; the current options are limited to delivery. The purpose of this review is to summarize the knowledge of the possible novel prophylactic therapies and screening methods for preeclampsia, thereby providing valuable insights for healthcare professionals and researchers. Aspirin and LMWH have already been widely used; meanwhile, calcium, vitamin D, and pravastatin show promise, and endothelin receptor antagonists are being explored. Stress reduction, dietary changes, and lifestyle modifications are also being investigated. Another interesting and fast-growing area is AI- and software-based screening methods. It is also key to find novel biomarkers, which, in some cases, are not only able to predict the development of the disease, but some of them hold promise to be a potential therapeutic target. We conclude that, while a definitive cure for preeclampsia may not be eligible in the near future, it is likely that the assessment and enhancement of preventive methods will lead to the prevention of many cases. However, it is also important to highlight that more additional research is needed in the future to clarify the exact pathophysiology of preeclampsia and to thus identify potential therapeutic targets for more improved treatment methods.

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“…Additionally, women with PE are more likely to suffer adverse cardiovascular events later in life [ 6 , 7 ]. Despite these challenges, the most effective treatment for PE often involves delivering the baby prematurely, leading to iatrogenic preterm birth [ 8 ]. Therefore, ongoing efforts are being made to understand the key mechanisms underlying the pathogenesis of PE, aiming to discover the potentially effective preventative and therapeutic strategies [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of changes in thiol-disulfide homeostasis during preeclampsia

Wang,

Yang,

You

et al. 2023

Biomol Biomed

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The present study systematically assessed alterations in thiol-disulfide homeostasis among women with preeclampsia (PE) through meta-analysis. This was conducted as such changes are believed to be associated with the oxidative stress underlying this condition. A comprehensive search of Medline, Web of Science, and Embase databases was conducted from their inception until 22 March 2023, to identify studies comparing levels of native thiol, total thiol, and disulfide between pregnant women with PE and those without PE. Results were pooled using a random-effects model to account for study heterogeneity. The analysis included a total of 631 women diagnosed with PE and 668 healthy pregnant women, encompassing 13 case-control studies and 1 prospective study. Pooled outcomes revealed that women with PE had significantly lower blood levels of native thiol, (mean difference [MD] -51.42 umol/L; 95% confidence interval [CI] -79.75 to -23.10 umol/L; P < 0.001; I2 = 0% and total thiol (MD -65.56 umol/L; 95% CI -104.97 to -26.15 umol/L; P = 0.001; I2 = 0%) compared to the control group. In contrast, no significant difference was observed in blood disulfide levels between the two groups (MD -1.10 umol/L; 95% CI -4.41 to -2.21 umol/L; P = 0.51; I2 = 0%). Subgroup analyses indicated that the results were consistent across studies matched by gestational age and body mass index, as well as those with varying quality scores (P for subgroup differences all > 0.05). In conclusion, women with PE are associated with significantly reduced blood levels of native and total thiols but show no change in blood disulfide levels, suggesting a state of reduced antioxidants in PE.

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Comparative effectiveness of prophylactic strategies for preeclampsia: a network meta-analysis of randomized controlled trials

Cited by 16 publications

References 40 publications

Low-molecular-weight heparin for the prevention of preeclampsia in high-risk pregnancies without thrombophilia: a systematic review and meta-analysis

Low-molecular-weight heparin for the prevention of preeclampsia in high-risk pregnancies without thrombophilia: a systematic review and meta-analysis

Recent Advances in the Prevention and Screening of Preeclampsia

Meta-analysis of changes in thiol-disulfide homeostasis during preeclampsia

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