Pharmacotherapy for Preeclampsia in Low and Middle Income Countries: An Analysis of Essential Medicines Lists

Abstract

Objective: To determine the prevalence of drugs for comprehensive management of preeclampsia in national essential medicine lists (EMLs) in low and middle income countries (LMICs) Methods:We collected EMLs from the 144 LMICs identi ed by the World Bank through broad-based Internet searches and in collaboration with the World Health Organization We identi ed therapies for hypertension, eclampsia, preeclampsia complications (eg, pulmonary edema, thrombosis), preterm birth, and labour induction contained in the EMLs Resuts:In 91 EMLs obtained from 144 LMICs, the most commonly listed parenteral antihypertensive therapies were verapamil (637%), hydralazine (615%), sodium nitroprusside (483%), and propranolol (396%) The most prevalent oral antihypertensive therapies were nifedipine (956%), methyldopa (934%), propranolol (901%), and atenolol (879%) For eclampsia/ preeclampsia, magnesium sulphate was present in 846% of EMLs and calcium gluconate in 857% For pulmonary edema, most EMLs (945%) listed oral furosemide, for thrombosis 923% listed heparin, for acceleration of fetal pulmonary maturity 901% listed parenteral dexamethasone, and for labour induction 978% listed oxytocin or a prostanoid (usually misoprostol, 407%) Concusion: EMLs of LMICs provide comprehensive coverage of preeclampsia pharmacotherapy These EMLs may be used as advocacy tools to ensure the availability of these therapies within each country RésuméObjectif : Déterminer la prévalence des médicaments permettant la prise en charge exhaustive de la prééclampsie au sein des listes de médicaments essentiels (LME) nationales des pays ne disposant que d'un revenu faible ou moyen (PRFM)Méthodes : Nous avons regroupé les LME des 144 PRFM identi és par la Banque mondiale par l'intermédiaire de recherches généralisées sur Internet et en collaboration avec l'Organisation mondiale de la santé Nous avons identi é, au sein des LME, les traitements visant l'hypertension, l'éclampsie, les complications de la prééclampsie (p ex oedème pulmonaire, thrombose), l'accouchement préterme et le déclenchement du travailRésutats : Au sein des 91 LME obtenues auprès de 144 PRFM, les traitements antihypertenseurs parentéraux apparaissant le plus couramment ont été les suivants : vérapamil (63,7 %), hydralazine (61,5 %), nitroprussiate de sodium (48,3 %) et propranolol (39,6 %) Les traitements antihypertenseurs oraux les plus prévalents ont été les suivants : nifédipine (95,6 %), méthyldopa 216 l MARCH JOGC MARS 2013 OBSTETRICS (93,4 %), propranolol (90,1 %) et aténolol (87,9 %) Pour ce qui est de l'éclampsie / la prééclampsie, le sulfate de magnésium gurait dans 84,6 % des LME et le gluconate de calcium, dans 85,7 % de celles-ci Pour ce qui est de l'oedème pulmonaire, le furosémide oral gurait dans la plupart des LME (94,5 %); pour ce qui est de la thrombose, l'héparine gurait dans 92,3 % des LME; pour ce qui est de l'accélération de la maturité pulmonaire foetale, la dexaméthasone parentérale gurait dans 90,1 % des LME; et pour ce qui es...

Reducing maternal mortality from preeclampsia and eclampsia in low‐resource countries – what should work?

“…However, we did not model the impact of these medications because we found no published studies documenting specific reductions in maternal mortality associated with this intervention. This finding is consistent with the WHO recommendations for PE/E, which concluded there was very low quality evidence for antihypertensives to treat women with severe PE/E but, based on expert opinion, included them in the WHO Essential Medicines List . Therefore, while antihypertensives are frequently recommended for women with severe hypertension to prevent hemorrhagic stroke, at present we are unable to substantiate a measure of efficacy to model this intervention.…”

Oral antihypertensive therapy for severe hypertension in pregnancy and postpartum: a systematic review

“…Second, options for oral antihypertensive therapy are available; the 2012 Priority Medicines for Mothers and Children, a list of essential life‐saving medications for women and children, has included methyldopa and hydralazine as antihypertensive agents, and nifedipine is also listed (albeit as a tocolytic) . All of these medications are on the essential medicines lists of most low‐ and middle‐income countries . Finally, based on proven effectiveness for treatment of severe hypertension outside pregnancy, there may be other treatment options that have not been studied in pregnancy or particularly, postpartum.…”

State-of-the-Art Diagnosis and Treatment of Hypertension in Pregnancy

“…63 Methyldopa, labetalol, and nifedipine, in doses listed in Table 2, are the most commonly recommended antihypertensive agents in international practice guidelines, although oral labetalol is not widely available in low-and middle-income countries. 64 Vitamin D has been reported to enhance the effectiveness of nifedipine. 41 Thiazide diuretics can be considered for hypertensive women, but their use is limited to specific circumstances, such as medullary sponge kidney, despite concerns that they may inhibit the normal plasma volume expansion of pregnancy.…”