Can preeclampsia be prevented?

Can preeclampsia be prevented?

Preeclampsia, defined as new onset of hypertension (≥140/90 mmHg), usually after 20 weeks of gestation associated with proteinuria, ⁽¹⁾ complicates 2-3% of all pregnancies ⁽²⁾ and is one of the main causes of maternal mortality ranging from 1.5 % to 2.9 %, sometimes causing postpartum hemorrhage, placental abruption, coagulopathy, renal failure, hypertensive encephalopathy, intracerebral hemorrhage and HELLP syndrome. ⁽³⁾

Usually, to find a cure for a disease, its origin must be well known; the fact is that preeclampsia is a disease where there are currently multiple theories where the one that seems closest is an abnormal placentation; An imbalance of anti-angiogenic and pro-angiogenic factors has also been demonstrated, as well as thromboxane – prostaglandins imbalance, and even immunological and genetic factors.

Until now, what has proven to be effective is delivery and removal of the placenta, however, this action could end in many neonatal complications depending on the gestational age; it’s like a fight between the fetus and the mother, therefore, it is to be expected that preeclampsia also has an important role as a cause of neonatal morbidity and mortality due to prematurity, restricted fetal growth and low birth weight. ⁽³⁾

Most of the time, hypertension is asymptomatic, and when it presents symptoms such as severe headache, decreased urine volume, severe epigastric pain, visual disturbances; and this makes the prognosis increasingly unfavorable. That is why prenatal care plays an important role in preventing pre-eclampsia, in fact, studies have shown that women who did not have prenatal care had a higher risk of death from pre-eclampsia or eclampsia compared to women who did have prenatal care. ⁽⁴⁾ And why is this important? Prenatal control seeks to identify, through clinical history, sociodemographic characteristics, mean blood pressure, Doppler of the uterine arteries and biochemical markers such as pregnancy-associated plasma protein A (PAPP-A) and placental growth factor (PlGF), those women who are at high risk of developing preeclampsia in order to take appropriate measures. that can help reduce that risk. ⁽⁵⁾

In recent years, efforts have been made to develop strategies that allow preeclampsia to be prevented in some way and many of them, although they seem to help slightly, there is not enough evidence to prove it, ⁽²⁾ such as, for example, physical rest, exercise, low salt intake, garlic, antioxidants, fish oil, progesterone and diuretics. On the other hand, low-dose aspirin, especially when initiated before 16 weeks, in moderate and high-risk women (previously identified), and calcium supplementation in populations with low calcium intake, have shown encouraging results in prevention of early preeclampsia, that is, that which occurs before 34 weeks, and restricted fetal growth (FGR). ⁽⁶⁾

Of course, before planning pregnancy, all women are recommended to adopt healthy lifestyles such as a proper diet, regular physical activity and attend a preconception consultation to identify risk factors that may trigger adverse perinatal outcomes, not just preeclampsia but to a large number of medical pathologies associated or not with pregnancy.

 Blog post and Photo by Dr. Nestor Ferrer, Ob/Gyn, for Maternova, Venezuela

1. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin Summary, Number 222. Obstet Gynecol. 2020;135(6):1492-1495. doi:10.1097/AOG.0000000000003892
2. Bezerra Maia E Holanda Moura S, Marques Lopes L, Murthi P, da Silva Costa F. Prevention of preeclampsia. J Pregnancy. 2012;2012:435090. doi:10.1155/2012/435090.
3. Sánchez Sixto E.. Actualización en la epidemiología de la preeclampsia: update. Rev. peru. ginecol. obstet.2014;  60( 4 ): 309-320.
4. MacKay AP, Berg CJ, Atrash HK. Pregnancy-related mortality from preeclampsia and eclampsia. Obstet Gynecol. 2001;97(4):533-538. doi:10.1016/s0029-7844(00)01223-0
5. Poon LC, Nicolaides KH. First-trimester maternal factors and biomarker screening for preeclampsia. Prenat Diagn. 2014;34(7):618-627. doi:10.1002/pd.4397
6. Bujold E, Roberge S, Lacasse Y, et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstetrics & Gynecology. 2010;116(2, part 1):402–414.