Different strategies for preventing preeclampsia in high-risk pregnant women in China: a network meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHAO Yongzhao , ZHANG Man , SHENG Yuting ,  LIU Xinghui

Department of Gynecology and Obstetrics, Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

LIU Xinghui, Email: xinghuiliu@163.com

Keywords：

Preeclampsia; High-risk pregnancy; Pregnancy outcome; Network meta-analysis

DOI：

10.7507/1672-2531.202501092

Video：

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Objective To investigate the effectiveness of different drug use regimens in preventing the development of preeclampsia in high-risk pregnant women in China. Methods We searched CNKI, Wanfang, VIP, Pubmed, Embase, and Cochrane library databases. Randomized controlled trials (RCTs) of published studies on the prevention of the onset of preeclampsia in high-risk pregnant women in China were searched between January 2000 and August 2024. After two investigators independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and evaluated the included studies, a reticulated meta-analysis was performed using Stata 15.0 software. Results A total of 33 randomized controlled studies with 5 364 patients involving five pharmacological intervention regimens were included. Network meta-analysis showed that aspirin combined with vitamins and aspirin combined with calcium were more effective than aspirin alone up to 36 weeks in preventing the onset of preeclampsia. The results of the best probability ranking showed that aspirin combined with vitamins and aspirin combined with calcium had a higher probability of being optimal for preventing the onset of preeclampsia. Conclusion Aspirin is effective in preventing the development of preeclampsia in high-risk pregnant women in China, but it is necessary to develop an individual combination management plan according to the patient's specific situation.

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2.	Poon L C, Shennan A, Hyett JA, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: a pragmatic guide for first-trimester screening and prevention. Int J Gynaecol Obstet, 2019, 145(Suppl 1): 1-33.
3.	Magee LA, Brown MA, Hall DR, et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens, 2022, 27: 148-169.
4.	Davis EF, Lazdam M, Lewandowski AJ, et al. Cardiovascular risk factors in children and young adults born to preeclamptic pregnancies: a systematic review. Pediatrics, 2012, 129(6): e1552-1561.
5.	Wu P, Green M, Myers JE. Hypertensive disorders of pregnancy. BMJ, 2023, 381: e071653.
6.	Garovic VD, Dechend R, Easterling T, et al. Hypertension in pregnancy: diagnosis, blood pressure goals, and pharmacotherapy: a scientific statement from the American Heart Association. Hypertension, 2022, 79(2): e21-e41.
7.	Chen Y, Peng Q, Yang Y, et al. The prevalence and increasing trends of overweight, general obesity, and abdominal obesity among Chinese adults: a repeated cross-sectional study. BMC Public Health, 2019, 19(1): 1293.
8.	Zhu C, Zhang S, Shen L, et al. Changes in the characteristics and outcomes of high-risk pregnant women who delivered prior to and after China's universal two-child policy: a real-world retrospective study, 2010-2021. BMC Public Health, 2024, 24(1): 336.
9.	Dimitriadis E, Rolnik DL, Zhou W, et al. Pre-eclampsia. Nat Rev Dis Primers, 2023, 9(1): 8.
10.	Liu YH, Zhang YS, Chen JY, et al. Comparative effectiveness of prophylactic strategies for preeclampsia: a network meta-analysis of randomized controlled trials. Am J Obstet Gynecol, 2023, 228(5): 535-546.
11.	Jones Pullins M, Boggess K, Porter TF. Aspirin in Pregnancy. Obstet Gynecol, 2023, 142(6): 1333-1340.
12.	Rolnik DL, Nicolaides KH, Poon LC. Prevention of preeclampsia with aspirin. Am J Obstet Gynecol, 2022, 226(2s): S1108-S1119.
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14.	ACOG Committee Opinion No. 743: Low-dose aspirin use during pregnancy. Obstet Gynecol, 2018, 132(1): e44-e52.
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26.	Jung E, Romero R, Yeo L, et al. The etiology of preeclampsia. Am J Obstet Gynecol, 2022, 226(2S): S844-S866.
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28.	Lu X, Wang Y, Geng N, et al. Dysregulated mitochondrial calcium causes spiral artery remodeling failure in preeclampsia. Hypertension, 2024, 81(11): 2368-2382.
29.	Melchiorre K, Giorgione V, Thilaganathan B. The placenta and preeclampsia: villain or victim. Am J Obstet Gynecol, 2022, 226(2S): S954-S962.
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1. 中华医学会妇产科学分会妊娠期高血压疾病学组. 妊娠期高血压疾病诊治指南(2020). 中华妇产科杂志, 2020, 55(4): 227-238.
2. Poon L C, Shennan A, Hyett JA, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: a pragmatic guide for first-trimester screening and prevention. Int J Gynaecol Obstet, 2019, 145(Suppl 1): 1-33.
3. Magee LA, Brown MA, Hall DR, et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens, 2022, 27: 148-169.
4. Davis EF, Lazdam M, Lewandowski AJ, et al. Cardiovascular risk factors in children and young adults born to preeclamptic pregnancies: a systematic review. Pediatrics, 2012, 129(6): e1552-1561.
5. Wu P, Green M, Myers JE. Hypertensive disorders of pregnancy. BMJ, 2023, 381: e071653.
6. Garovic VD, Dechend R, Easterling T, et al. Hypertension in pregnancy: diagnosis, blood pressure goals, and pharmacotherapy: a scientific statement from the American Heart Association. Hypertension, 2022, 79(2): e21-e41.
7. Chen Y, Peng Q, Yang Y, et al. The prevalence and increasing trends of overweight, general obesity, and abdominal obesity among Chinese adults: a repeated cross-sectional study. BMC Public Health, 2019, 19(1): 1293.
8. Zhu C, Zhang S, Shen L, et al. Changes in the characteristics and outcomes of high-risk pregnant women who delivered prior to and after China's universal two-child policy: a real-world retrospective study, 2010-2021. BMC Public Health, 2024, 24(1): 336.
9. Dimitriadis E, Rolnik DL, Zhou W, et al. Pre-eclampsia. Nat Rev Dis Primers, 2023, 9(1): 8.
10. Liu YH, Zhang YS, Chen JY, et al. Comparative effectiveness of prophylactic strategies for preeclampsia: a network meta-analysis of randomized controlled trials. Am J Obstet Gynecol, 2023, 228(5): 535-546.
11. Jones Pullins M, Boggess K, Porter TF. Aspirin in Pregnancy. Obstet Gynecol, 2023, 142(6): 1333-1340.
12. Rolnik DL, Nicolaides KH, Poon LC. Prevention of preeclampsia with aspirin. Am J Obstet Gynecol, 2022, 226(2s): S1108-S1119.
13. 杨孜, 张为远. 《妊娠期高血压疾病诊治指南(2020)》解读. 中华妇产科杂志, 2020, 55(6): 425-432.
14. ACOG Committee Opinion No. 743: Low-dose aspirin use during pregnancy. Obstet Gynecol, 2018, 132(1): e44-e52.
15. Roberge S, Nicolaides K, Demers S, et al. 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(2): 110-120.
16. Jaiswal V, Joshi A, Jha M, et al. Association between calcium supplementation and gestational hypertension, and preeclampsia: A meta-analysis of 26 randomized controlled trials. Curr Probl Cardiol, 2024, 49(3): 102217.
17. Moghib K, Ghanm TI, Abunamoos A, et al. Efficacy of vitamin D supplementation on the incidence of preeclampsia: a systematic review and meta-analysis. BMC Pregnancy Childbirth, 2024, 24(1): 852.
18. Cruz-Lemini M, Vázquez JC, Ullmo J, et al. Low-molecular-weight heparin for prevention of preeclampsia and other placenta-mediated complications: a systematic review and meta-analysis. Am J Obstet Gynecol, 2022, 226(2S): S1126-S1144.
19. Zheng L, Xia B, Yuan Y, et al. Low-molecular-weight heparin in addition to low-dose aspirin for preventing preeclampsia and its complications: a systematic review and meta-analysis. Front Cardiovasc Med, 2022, 9: 1073148.
20. Roberge S, Demers S, Nicolaides KH, et al. Prevention of pre-eclampsia by low-molecular-weight heparin in addition to aspirin: a meta-analysis. Ultrasound Obstet Gynecol, 2016, 47(5): 548-553.
21. Wang X, Gao H. Prevention of preeclampsia in high-risk patients with low-molecular-weight heparin: a meta-analysis. J Matern Fetal Neonatal Med, 2020, 33(13): 2202-2208.
22. Brown MA, Magee LA, Kenny LC, et al. The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens, 2018, 13: 291-310.
23. Horgan R, Hage Diab Y, Waller J, et al. Low-dose aspirin therapy for the prevention of preeclampsia: time to reconsider our recommendations. Am J Obstet Gynecol, 2023, 229(4): 410-418.
24. US Preventive Services Task Force. Davidson KW, Barry MJ, Mangione CM, et al. Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: US Preventive Services Task Force Recommendation Statement. JAMA, 2021, 326(12): 1186-1191.
25. FIGO Working Group on Good Clinical Practice in Maternal-Fetal Medicine. Good clinical practice advice: first trimester screening and prevention of pre-eclampsia in singleton pregnancy. Int J Gynaecol Obstet, 2019, 144(3): 325-329.
26. Jung E, Romero R, Yeo L, et al. The etiology of preeclampsia. Am J Obstet Gynecol, 2022, 226(2S): S844-S866.
27. Liu X, Zhang X, Ma L, et al. 1, 25-Dihydroxyvitamin D3 protects against placental inflammation by suppressing NLRP3-mediated IL-1β production via Nrf2 signaling pathway in preeclampsia. Metabolism, 2025, 162: 156058.
28. Lu X, Wang Y, Geng N, et al. Dysregulated mitochondrial calcium causes spiral artery remodeling failure in preeclampsia. Hypertension, 2024, 81(11): 2368-2382.
29. Melchiorre K, Giorgione V, Thilaganathan B. The placenta and preeclampsia: villain or victim. Am J Obstet Gynecol, 2022, 226(2S): S954-S962.
30. Grotegut CA. Prevention of preeclampsia. J Clin Invest, 2016, 126(12): 4396-4398.
31. Tong S, Kaitu'u-Lino TJ, Hastie R, et al. Pravastatin, proton-pump inhibitors, metformin, micronutrients, and biologics: new horizons for the prevention or treatment of preeclampsia. Am J Obstet Gynecol, 2022, 226(2S): S1157-S1170.
32. 刘冬梅, 洪燕. 孕期口服维生素D预防子痫前期的效果及对孕妇妊娠结局的影响. 现代实用医学, 2020, 32(8): 964-965,975.
33. 米芸. 小剂量阿司匹林在子痫前期高危人群中的预防价值分析. 实用妇科内分泌电子杂志, 2021, 8(19): 14-17.
34. 胡国秀. 小剂量阿司匹林预防妊娠期高血压疾病的效果观察. 中外医学研究, 2018, 16(20): 17-19.
35. 邓琼, 江丹丹, 莫萍, 等. 小剂量阿司匹林预防妊娠期高血压疾病的效果分析. 中国实用医药, 2020, 15(19): 135-136.
36. 邹小玲. 小剂量阿司匹林预防高危孕妇子痫前期及母婴预后分析. 中国社区医师, 2019, 35(27): 79-80.
37. 刘津予. 小剂量阿司匹林预防高危孕妇子痫前期的临床效果观察. 广西医学, 2017, 39(3): 347-349.
38. 刘爱华, 刘冬梅, 白俊丽. 小剂量阿司匹林联合钙剂在高危人群预防子痫前期的临床体会. 中国当代医药, 2016, 23(23): 81-83.
39. 张飞芳, 郑秀娟, 范徐妃, 等. 小剂量阿司匹林或联合低分子肝素预防子痫前期效果评价. 浙江医学, 2018, 40(17): 1918-1921.
40. 孙红霞, 蔡娱飞, 马哲, 等. 小剂量阿司匹林对子痫前期高危孕妇发生子痫前期的预防作用及其机制. 吉林大学学报(医学版), 2020, 46(1): 138-143.
41. 马国芳, 张喜梅. 维生素E联合小剂量阿司匹林对子痫前期高危孕妇母婴结局的改善效果及其可能机制. 广西医学, 2020, 42(14): 1836-1839.
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