子痫前期非药物及药物预防的研究进展

doi:10.12280/gjfckx.20250094

摘要/Abstract

摘要：

子痫前期是妊娠期常见的高危并发症，主要表现为高血压、水肿和大量蛋白尿，严重时可导致母婴死亡等一系列严重并发症。子痫前期的预防主要包括非药物预防和药物预防。子痫前期的非药物预防主要聚焦于生活方式优化及系统化孕期管理，包括均衡膳食、规律运动、依据孕前体质量指数对孕期体质量进行分层管理。同时，临床医生应在妊娠早期结合患者的病史、查体和相关实验室检测结果精准识别子痫前期高危人群，进行个性化预防，以改善母婴长期预后。药物预防方面，低剂量阿司匹林（60~150 mg/d）作为循证依据最充分的干预手段，被多国指南推荐用于高危孕妇的早期预防；钙补充剂（≥1 g/d）也可降低患子痫前期的风险，尤其适用于低钙摄入人群；维生素D（600~2 000 IU/d）通过免疫调节及抗氧化作用显示出其潜在的子痫前期的预防价值。此外，他汀类药物、二甲双胍和埃索美拉唑等尚处于临床研究阶段，虽初步证据支持其疗效，但安全性仍需大样本验证。

关键词: 先兆子痫, 早期医疗干预, 药物疗法, 阿司匹林, 孕期体重增长

Abstract:

Preeclampsia is a common high-risk complication during pregnancy, mainly manifested as hypertension, edema and massive proteinuria. In severe cases, it can lead to a series of serious complications such as maternal and neonatal mortality. The prevention of preeclampsia mainly includes non-pharmacological and pharmacological preventions. Non-pharmacological prevention of preeclampsia mainly focus on lifestyle optimization and systematic pregnancy management, including a balanced diet, regular exercise, and stratified weight management based on pre-pregnancy body mass index. At the same time, clinicians should accurately identify high-risk groups for preeclampsia in the early stage of pregnancy by combining the patient′s medical history, physical examination, and relevant laboratory test results, and carry out personalized prevention to improve the long-term prognosis of maternal and fetal outcomes. In terms of pharmacological prevention, low-dose aspirin (60-150 mg/d), as the most evidence-based intervention, is recommended by many national guidelines for early prevention in high-risk pregnant women. Calcium supplements (≥1 g/d) can also reduce the risk of preeclampsia, especially for people with low calcium intake. Vitamin D (600-2 000 IU/d) demonstrates its potential value in preventing preeclampsia through immunomodulatory and antioxidant effects. Additionally, statins, metformin, and esomeprazole, etc. are still in the stage of clinical research. Although preliminary evidence supports their efficacy, their safety still needs to be verified by large-scale samples.

Key words: Pre-eclampsia, Early medical intervention, Drug therapy, Aspirin, Gestational weight gain

秦晓培, 周齐. 子痫前期非药物及药物预防的研究进展[J]. 国际妇产科学杂志, 2025, 52(3): 280-285.

QIN Xiao-pei, ZHOU Qi. Research Progress on Non-Pharmacological and Pharmacological Prevention of Preeclampsia[J]. Journal of International Obstetrics and Gynecology, 2025, 52(3): 280-285.

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运动类型	运动强度	频率（次/周）	时长（min）	适应人群
孕妇瑜伽	Borg量表13~14分	3~5	40~60	无运动禁忌的普通孕妇
步行	控制心率为HRmax的55%~65%	5~7	30~45	BMI<30 kg/m²的初产妇
水中运动	改良后的RPE为3~4级	2~3	45~60	合并关节疼痛或肥胖的孕妇
抗阻训练	1RM的40%~50%	2~3	20~30	孕前有规律力量训练史者

运动类型	运动强度	频率（次/周）	时长（min）	适应人群
孕妇瑜伽	Borg量表13~14分	3~5	40~60	无运动禁忌的普通孕妇
步行	控制心率为HRmax的55%~65%	5~7	30~45	BMI<30 kg/m²的初产妇
水中运动	改良后的RPE为3~4级	2~3	45~60	合并关节疼痛或肥胖的孕妇
抗阻训练	1RM的40%~50%	2~3	20~30	孕前有规律力量训练史者

孕前BMI（kg/m²）	孕前体质量分类	孕期总增重（kg）	孕中晚期体质量增长速度*（kg/周）
BMI<18.5	低体质量	11.0~16.0	0.51（0.44~0.58）
18.5≤BMI<24.0	正常体质量	8.0~14.0	0.42（0.35~0.50）
24.0≤BMI<28.0	超重	7.0~11.0	0.28（0.23~0.33）
BMI≥28.0	肥胖	5.0~9.0	0.22（0.17~0.27）

孕前BMI（kg/m²）	孕前体质量分类	孕期总增重（kg）	孕中晚期体质量增长速度*（kg/周）
BMI<18.5	低体质量	11.0~16.0	0.51（0.44~0.58）
18.5≤BMI<24.0	正常体质量	8.0~14.0	0.42（0.35~0.50）
24.0≤BMI<28.0	超重	7.0~11.0	0.28（0.23~0.33）
BMI≥28.0	肥胖	5.0~9.0	0.22（0.17~0.27）