Research Progress on Non-Pharmacological and Pharmacological Prevention of Preeclampsia

doi:10.12280/gjfckx.20250094

Abstract

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

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.

Figures/Tables 2

References 40

[1]	Rosenberg EA, Seely EW. Update on Preeclampsia and Hypertensive Disorders of Pregnancy[J]. Endocrinol Metab Clin North Am, 2024, 53(3):377-389. doi: 10.1016/j.ecl.2024.05.012.
[2]	Yang M, Wang M, Li N. Advances in pathogenesis of preeclampsia[J]. Arch Gynecol Obstet, 2024, 309(5):1815-1823. doi: 10.1007/s00404-024-07393-6.
[3]	Kornacki J, Olejniczak O, Sibiak R, et al. Pathophysiology of Pre-Eclampsia-Two Theories of the Development of the Disease[J]. Int J Mol Sci, 2023, 25(1):307. doi: 10.3390/ijms25010307.
[4]	Mishima S, Mitsui T, Tani K, et al. Endothelin-1 production via placental (pro)renin receptor in a mouse model of preeclampsia[J]. Placenta, 2023, 138:44-50. doi: 10.1016/j.placenta.2023.05.002. pmid: 37167782
[5]	de Ganzo Suárez T, de Paco Matallana C, Plasencia W. Spiral, uterine artery doppler and placental ultrasound in relation to preeclampsia[J]. Best Pract Res Clin Obstet Gynaecol, 2024,92:102426. doi: 10.1016/j.bpobgyn.2023.102426.
[6]	Zamir M, Nelson DM, Ginosar Y. Hemodynamic consequences of incomplete uterine spiral artery transformation in human pregnancy, with implications for placental dysfunction and preeclampsia[J]. J Appl Physiol(1985), 2021, 130(2):457-465. doi: 10.1152/japplphysiol.00504.2020.
[7]	Deer E, Herrock O, Campbell N, et al. The role of immune cells and mediators in preeclampsia[J]. Nat Rev Nephrol, 2023, 19(4):257-270. doi: 10.1038/s41581-022-00670-0. pmid: 36635411
[8]	Horvat Mercnik M, Schliefsteiner C, Sanchez-Duffhues G, et al. TGFβ signalling: a nexus between inflammation, placental health and preeclampsia throughout pregnancy[J]. Hum Reprod Update, 2024, 30(4):442-471. doi: 10.1093/humupd/dmae007.
[9]	Imanpour V, Khoshhali M, Goodarzi-Khoigani M, et al. Systematic review and meta-analysis of nutritional interventions to prevent of gestational hypertension or/and preeclampsia among healthy pregnant women[J]. J Res Med Sci, 2023,28:25. doi: 10.4103/jrms.jrms_89_22.
[10]	Poniedziałek-Czajkowska E, Mierzyński R, Leszczyńska-Gorzelak B. Preeclampsia and Obesity-The Preventive Role of Exercise[J]. Int J Environ Res Public Health, 2023, 20(2):1267. doi: 10.3390/ijerph20021267.
[11]	Liu YH, Zhang YS, Chen JY, et al. Comparative effectiveness of prophylactic strategies for preeclampsia: a network meta-analysis of randomized controlled trials[J]. Am J Obstet Gynecol, 2023, 228(5):535-546. doi: 10.1016/j.ajog.2022.10.014.
[12]	Mottola MF, Davenport MH, Ruchat SM, et al. No.367-2019 Canadian Guideline for Physical Activity throughout Pregnancy[J]. J Obstet Gynaecol Can, 2018, 40(11):1528-1537. doi: 10.1016/j.jogc.2018.07.001.
[13]	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[J]. Pregnancy Hypertens, 2022, 27:148-169. doi: 10.1016/j.preghy.2021.09.008.
[14]	Robillard PY, Dekker G, Scioscia M, et al. Increased BMI has a linear association with late-onset preeclampsia: A population-based study[J]. PLoS One, 2019, 14(10):e0223888. doi: 10.1371/journal.pone.0223888.
[15]	王芳. 孕妇体重和孕期行为生活方式与妊娠期高血压疾病的关系[D]. 太原: 山西医科大学, 2015.
[16]	中华人民共和国国家卫生健康委员会. 妊娠期妇女体重增长推荐值标准[EB/OL]. (2022-07-28)[2025-02-09]. http://www.nhc.gov.cn/wjw/fyjk/202208/864ddc16511148819168305d3e576de9.shtml.
[17]	Chapuis-de-Andrade S, Moret-Tatay C, de Paula TA, et al. Psycho-logical factors and coping strategies in pregnancies complicated by hypertension: A cluster-analytic approach[J]. J Affect Disord, 2022, 296:89-94. doi: 10.1016/j.jad.2021.09.049.
[18]	Gholami K, Norouzkhani N, Kargar M, et al. Impact of Educational Interventions on Knowledge About Hypertensive Disorders of Pregnancy Among Pregnant Women: A Systematic Review[J]. Front Cardiovasc Med, 2022,9:886679. doi: 10.3389/fcvm.2022.886679.
[19]	李健鑫, 陈真, 漆洪波. 阿司匹林预防子痫前期:从证据到应用规范[J]. 中华围产医学杂志, 2024, 27(4):265-271. doi: 10.3760/cma.j.cn113903-20240115-00024.
[20]	赵维丽, 胡丽燕. 阿司匹林预防子痫前期的研究进展[J]. 中国药物与临床, 2024, 24(2):84-87. doi: 10.11655/zgywylc2024.02.004.
[21]	ACOG Practice Bulletin No.202: Gestational Hypertension and Preeclampsia[J]. Obstet Gynecol, 2019, 133(1):1. doi: 10.1097/AOG.0000000000003018.
[22]	Richards EMF, Giorgione V, Stevens O, et al. Low-dose aspirin for the prevention of superimposed preeclampsia in women with chronic hypertension: a systematic review and meta-analysis[J]. Am J Obstet Gynecol, 2023, 228(4):395-408. doi: 10.1016/j.ajog.2022.09.046.
[23]	Hofmeyr GJ, Lawrie TA, Atallah ÁN, et al. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems[J]. Cochrane Database Syst Rev, 2018, 10(10):CD001059. doi: 10.1002/14651858.CD001059.pub5.
[24]	WHO recommendation: Calcium supplementation during pregnancy for the prevention of pre-eclampsia and its complications[M]. Geneva: World Health Organization, 2018.
[25]	Ushida T, Tano S, Matsuo S, et al. Dietary supplements and prevention of preeclampsia[J]. Hypertens Res, 2025, 48(4):1444-1457. doi: 10.1038/s41440-025-02144-9.
[26]	Wang R, Xu F, Xia X, et al. The effect of vitamin D supplementation on primary depression: A meta-analysis[J]. J Affect Disord, 2024, 344:653-661. doi: 10.1016/j.jad.2023.10.021.
[27]	Yang WC, Chitale R, O′Callaghan KM, et al. The Effects of Vitamin D Supplementation During Pregnancy on Maternal, Neonatal, and Infant Health: A Systematic Review and Meta-analysis[J]. Nutr Rev, 2025, 83(3):e892-e903. doi: 10.1093/nutrit/nuae065.
[28]	Grant WB, Wimalawansa SJ, Pludowski P, et al. Vitamin D: Evidence-Based Health Benefits and Recommendations for Population Guidelines[J]. Nutrients, 2025, 17(2):277. doi: 10.3390/nu17020277.
[29]	Jerkovic Raguž M, Barišic T, Mikulic I, et al. The Correlation of Vitamin D Concentrations in Healthy Pregnant Women and Their Infants with Outcome Parameters[J]. Z Geburtshilfe Neonatol, 2025 Mar 11. doi: 10.1055/a-2542-2818.
[30]	Costantine MM, Cleary K, Hebert MF, et al. Safety and pharmacokinetics of pravastatin used for the prevention of preeclampsia in high-risk pregnant women: a pilot randomized controlled trial[J]. Am J Obstet Gynecol, 2016, 214(6):720.e1-720.e17. doi: 10.1016/j.ajog.2015.12.038.
[31]	Akbar M, Azis MA, Riu DS, et al. INOVASIA Study: A Multicenter Randomized Clinical Trial of Pravastatin to Prevent Preeclampsia in High-Risk Patients[J]. Am J Perinatol, 2024, 41(9):1203-1211. doi: 10.1055/a-1798-1925.
[32]	Mészáros B, Veres DS, Nagyistók L, et al. Pravastatin in preeclampsia: A meta-analysis and systematic review[J]. Front Med(Lausanne), 2023,9:1076372. doi: 10.3389/fmed.2022.1076372.
[33]	Paraskevas T, Gakis G, Papapanou M, et al. Statins for preventing preeclampsia[J]. Cochrane Database Syst Rev, 2025, 3(3):CD016133. doi: 10.1002/14651858.CD016133.
[34]	中国血脂管理指南修订联合专家委员会. 中国血脂管理指南(2023年)[J]. 中国循环杂志, 2023, 38(3):237-271. doi: 10.3969/j.issn.1000-3614.2023.03.001.
[35]	黄谊红, 王子莲. 妊娠期高血脂患者的管理[J]. 实用妇产科杂志, 2023, 39(5): 333-336. doi: 1003-6946(2023)05-0333-04.
[36]	Costantine MM, West H, Wisner KL, et al. A randomized pilot clinical trial of pravastatin versus placebo in pregnant patients at high risk of preeclampsia[J]. Am J Obstet Gynecol, 2021, 225(6):666.e1-666.e15. doi: 10.1016/j.ajog.2021.05.018.
[37]	宁蓓蓓, 邓丽君, 马惠静, 等. 二甲双胍防治子痫前期的研究进展[J]. 现代药物与临床, 2022, 37(12):2902-2905. doi: 10.7501/j.issn.1674-5515.2022.12.042.
[38]	Patel M, Battarbee AN, Refuerzo JS, et al. Association Between Metformin Use in Early Gestational or Type 2 Diabetes in Pregnancy and Preterm Preeclampsia[J]. Obstet Gynecol, 2024, 144(5):733-739. doi: 10.1097/AOG.0000000000005720. pmid: 39236318
[39]	Liu J, Shen L, Nguyen-Hoang L, et al. Aspirin versus metformin in pregnancies at high risk of preterm pre-eclampsia in China (AVERT): protocol for a multicentre, double-blind, 3-arm randomised controlled trial[J]. BMJ Open, 2024, 14(4):e074493. doi: 10.1136/bmjopen-2023-074493.
[40]	Cluver CA, Bergman L, Bergkvist J, et al. Impact of fetal growth restriction on pregnancy outcome in women undergoing expectant management for preterm pre-eclampsia[J]. Ultrasound Obstet Gynecol, 2023, 62(5):660-667. doi: 10.1002/uog.26282. pmid: 37289938

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）