The Prevention and Prediction of Pre-Eclampsia: Recent Advances and the Way Forward

doi:10.12280/gjfckx.20240134

Abstract

Abstract:

Pre-eclampsia is a leading cause of maternal and newborn mortality worldwide, impacting long-term health outcomes for both mother and child. We describe and analyze the limitations and controversies related to using aspirin for pre-eclampsia prevention, and explore the involvement of other medications in preventative strategies. Furthermore, this article examines the pre-eclampsia prediction scheme for both singleton and twin pregnancies, emphasizing the importance of tertiary referral systems in the prevention and treatment of pre-eclampsia, aiming to further promoting high-quality pre-eclampsia prevention and treatment and improve maternal and child health in China.

Key words: Pre-eclampsia, Chemoprevention, Forecasting, Aspirin, Therapy

WU Zhi-wei, LIN Xue-yan, ZHANG Xue-qin, YANG Mei-lin. The Prevention and Prediction of Pre-Eclampsia: Recent Advances and the Way Forward[J]. Journal of International Obstetrics and Gynecology, 2024, 51(3): 312-316.

References 42

[1]	Wang W, Xie X, Yuan T, et al. Epidemiological trends of maternal hypertensive disorders of pregnancy at the global, regional, and national levels: a population-based study[J]. BMC Pregnancy Childbirth, 2021, 21(1):364. doi: 10.1186/s12884-021-03809-2.
[2]	Li F, Qin J, Zhang S, et al. Prevalence of hypertensive disorders in pregnancy in China: A systematic review and meta-analysis[J]. Pregnancy Hypertens, 2021, 24:13-21. doi: 10.1016/j.preghy.2021.02.001. pmid: 33626437
[3]	Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222[J]. Obstet Gynecol, 2020, 135(6):e237-e260. doi: 10.1097/AOG.0000000000003891.
[4]	Dimitriadis E, Rolnik DL, Zhou W, et al. Pre-eclampsia[J]. Nat Rev Dis Primers, 2023, 9(1):8. doi: 10.1038/s41572-023-00417-6. pmid: 36797292
[5]	Pittara T, Vyrides A, Lamnisos D, et al. Pre-eclampsia and long-term health outcomes for mother and infant: an umbrella review[J]. BJOG, 2021, 128(9):1421-1430. doi: 10.1111/1471-0528.16683.
[6]	Rolnik DL, Wright D, Poon LC, et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia[J]. N Engl J Med, 2017, 377(7):613-622. doi: 10.1056/NEJMoa1704559.
[7]	Hoffman MK, Goudar SS, Kodkany BS, et al. Low-dose aspirin for the prevention of preterm delivery in nulliparous women with a singleton pregnancy (ASPIRIN): a randomised, double-blind, placebo-controlled trial[J]. Lancet, 2020, 395(10220):285-293. doi: 10.1016/S0140-6736(19)32973-3. pmid: 31982074
[8]	Wright D, Akolekar R, Syngelaki A, et al. A competing risks model in early screening for preeclampsia[J]. Fetal Diagn Ther, 2012, 32(3):171-178. doi: 10.1159/000338470. pmid: 22846473
[9]	Wright D, Nicolaides KH. Aspirin delays the development of preeclampsia[J]. Am J Obstet Gynecol, 2019, 220(6):580.e1-e6. doi: 10.1016/j.ajog.2019.02.034.
[10]	Lin L, Huai J, Li B, et al. A randomized controlled trial of low-dose aspirin for the prevention of preeclampsia in women at high risk in China[J]. Am J Obstet Gynecol, 2022, 226(2):251.e1-e12. doi: 10.1016/j.ajog.2021.08.004.
[11]	Banala C, Moreno S, Cruz Y, et al. Impact of the ACOG guideline regarding low-dose aspirin for prevention of superimposed preeclampsia in women with chronic hypertension[J]. Am J Obstet Gynecol, 2020, 223(3):419.e1-e16. doi: 10.1016/j.ajog.2020.03.004.
[12]	Seidler AL, Askie L, Ray JG. Optimal aspirin dosing for preeclampsia prevention[J]. Am J Obstet Gynecol, 2018, 219(1):117-118. doi: 10.1016/j.ajog.2018.03.018. pmid: 29588190
[13]	Roberge S, Bujold E, Nicolaides KH. Aspirin for the prevention of preterm and term preeclampsia: systematic review and meta analysis[J]. Am J Obstet Gynecol, 2018, 218(3):287-293.e1. doi: 10.1016/j.ajog.2017.11.561.
[14]	Tapp S, Guerby P, Girard M, et al. A Pilot Randomized Trial Comparing the Effects of 80 versus 160 mg of Aspirin on Midtrimester Uterine Artery Pulsatility Index in Women with a History of Preeclampsia[J]. J Obstet Gynaecol Can, 2020, 42(12):1498-1504. doi: 10.1016/j.jogc.2020.05.013. pmid: 32912725
[15]	Choi YJ, Shin S. Aspirin Prophylaxis During Pregnancy: A Systematic Review and Meta-Analysis[J]. Am J Prev Med, 2021, 61(1):e31-e45. doi: 10.1016/j.amepre.2021.01.032.
[16]	Mallampati D, Grobman W, Rouse DJ, et al. Strategies for Prescribing Aspirin to Prevent Preeclampsia: A Cost-Effectiveness Analysis[J]. Obstet Gynecol, 2019, 134(3):537-544. doi: 10.1097/AOG.0000000000003413. pmid: 31403606
[17]	Chaemsaithong P, Cuenca-Gomez D, Plana MN, et al. Does low-dose aspirin initiated before 11 weeks′ gestation reduce the rate of preeclampsia?[J]. Am J Obstet Gynecol, 2020, 222(5):437-450. doi: 10.1016/j.ajog.2019.08.047. pmid: 31494125
[18]	Pradhan M, Kishore SV, Champatiray J. Effect of low dose aspirin on maternal outcome in women at risk for developing pregnancy induced hypertension[J]. Int J Reprod Contracept Obstetr Gynecol, 2020, 9(4):1590-1596. doi: 10.18203/2320-1770.ijrcog20201229.
[19]	Amin O, Tasnim N, Naeem S. Prevention of pre-eclampsia with low dose aspirin in primigravida[J]. Womens Health, 2020, 9(1):28-32. doi: 10.15406/mojwh.2020.09.00264.
[20]	Ahmed A, Williams DJ, Cheed V, et al. Pravastatin for early-onset pre-eclampsia: a randomised, blinded, placebo-controlled trial[J]. BJOG, 2020, 127(4):478-488. doi: 10.1111/1471-0528.16013.
[21]	Mészáros B, Veres DS, Nagyistók L, et al. Pravastatin in preeclampsia: A meta-analysis and systematic review[J]. Front Med(Lausanne), 2022,9:1076372. doi: 10.3389/fmed.2022.1076372.
[22]	Romero R, Erez O, Hüttemann M, et al. Metformin, the aspirin of the 21st century: its role in gestational diabetes mellitus, prevention of preeclampsia and cancer, and the promotion of longevity[J]. Am J Obstet Gynecol, 2017, 217(3):282-302. doi: 10.1016/j.ajog.2017.06.003.
[23]	He K, Guo Q, Ge J, et al. The efficacy and safety of metformin alone or as an add-on therapy to insulin in pregnancy with GDM or T2DM: A systematic review and meta-analysis of 21 randomized controlled trials[J]. J Clin Pharm Ther, 2022, 47(2):168-177. doi: 10.1111/jcpt.13503.
[24]	Zhu D, Chen Y, Huang J, et al. Effects of metformin on pregnancy outcome, metabolic profile, and sex hormone levels in women with polycystic ovary syndrome and their offspring: a systematic review and meta-analysis[J]. Ann Transl Med, 2022, 10(7):418. doi: 10.21037/atm-22-909. pmid: 35530948
[25]	Nascimento I, Sales WB, Dienstmann G, et al. Metformin for prevention of cesarean delivery and large-for-gestational-age newborns in non-diabetic obese pregnant women: a randomized clinical trial[J]. Arch Endocrinol Metab, 2020, 64(3):290-297. doi: 10.20945/2359-3997000000251. pmid: 32555996
[26]	Magee LA, Nicolaides KH, von Dadelszen P. Preeclampsia[J]. N Engl J Med, 2022, 386(19):1817-1832. doi: 10.1056/NEJMra2109523.
[27]	Davenport MH, Ruchat SM, Poitras VJ, et al. Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis[J]. Br J Sports Med, 2018, 52(21):1367-1375. doi: 10.1136/bjsports-2018-099355.
[28]	Woo Kinshella ML, Sarr C, Sandhu A, et al. Calcium for pre-eclampsia prevention: A systematic review and network meta-analysis to guide personalised antenatal care[J]. BJOG, 2022, 129(11):1833-1843. doi: 10.1111/1471-0528.17222.
[29]	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[J]. JAMA, 2021, 326(12):1186-1191. doi: 10.1001/jama.2021.14781. pmid: 34581729
[30]	Zeisler H, Llurba E, Chantraine F, et al. Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia[J]. N Engl J Med, 2016, 374(1):13-22. doi: 10.1056/NEJMoa1414838.
[31]	Stepan H, Hund M, Dilba P, et al. Elecsys^® and Kryptor immunoassays for the measurement of sFlt-1 and PlGF to aid preeclampsia diagnosis: are they comparable?[J]. Clin Chem Lab Med, 2019, 57(9):1339-1348. doi: 10.1515/cclm-2018-1228.
[32]	The National Institute for Health and Care Excellence. PlGF-based testing to help diagnose suspected preterm pre-eclampsia. Diagnostics guidance[EB/OL]. [2022-07-27]. http://www.nice.org.uk/guidance/dg49.
[33]	Jhee JH, Lee S, Park Y, et al. Prediction model development of late-onset preeclampsia using machine learning-based methods[J]. PLoS One, 2019, 14(8):e0221202. doi: 10.1371/journal.pone.0221202.
[34]	Bergeron TS, Roberge S, Carpentier C, et al. Prevention of Preeclampsia with Aspirin in Multiple Gestations: A Systematic Review and Meta-analysis[J]. Am J Perinatol, 2016, 33(6):605-610. doi: 10.1055/s-0035-1570381. pmid: 26731178
[35]	Zhou Q, Zhao X, Xu J, et al. Low-dose aspirin in the prevention of preeclampsia in twin pregnancies: A real-world study[J]. Front Cardiovasc Med, 2022,9:964541. doi: 10.3389/fcvm.2022.964541.
[36]	De La Calle M, Delgado JL, Verlohren S, et al. Gestational Age-Specific Reference Ranges for the sFlt-1/PlGF Immunoassay Ratio in Twin Pregnancies[J]. Fetal Diagn Ther, 2021, 48(4):288-296. doi: 10.1159/000514378.
[37]	Dröge L, Herraìz I, Zeisler H, et al. Maternal serum sFlt-1/PlGF ratio in twin pregnancies with and without pre-eclampsia in comparison with singleton pregnancies[J]. Ultrasound Obstet Gynecol, 2015, 45(3):286-293. doi: 10.1002/uog.14760. pmid: 25491901
[38]	Shinohara S, Sunami R, Kasai M, et al. Predictive value of the sFlt-1/PlGF ratio for preeclampsia in twin pregnancies: a retrospective study[J]. Hypertens Pregnancy, 2021, 40(4):330-335. doi: 10.1080/10641955.2021.1987455.
[39]	Chen J, Zhao D, Liu Y, et al. Screening for preeclampsia in low-risk twin pregnancies at early gestation[J]. Acta Obstet Gynecol Scand, 2020, 99(10):1346-1353. doi: 10.1111/aogs.13890.
[40]	Yang M, Bai Y, Li M, et al. Predictive value of the soluble fms-like tyrosine kinase 1 to placental growth factor ratio for preeclampsia in twin pregnancies: a systematic review and meta-analysis[J]. Am J Obstet Gynecol MFM, 2024, 6(3):101290. doi: 10.1016/j.ajogmf.2024.101290.
[41]	林雪燕, 杨孜, 史峻梅, 等. 不同转诊时机对转诊系统内重度子痫前期孕妇妊娠结局的影响[J]. 中华妇产科杂志, 2022, 57(3):164-171. doi: 10.3760/cma.j.cn112141-20211211-00729.
[42]	林雪燕, 杨孜, 张雪芹, 等. 二线城市三级孕产妇转诊中心重度子痫前期临床特点分析[J]. 中华妇产科杂志, 2023, 58(6):423-429. doi: 10.3760/cma.j.cn112141-20230224-00086.