Global and regional estimates of preeclampsia and eclampsia: a systematic review
01 Sep 2013-European Journal of Obstetrics & Gynecology and Reproductive Biology (Elsevier)-Vol. 170, Iss: 1, pp 1-7
TL;DR: A systematic review of the incidence of hypertensive disorders of pregnancy (HDP) with the objective of evaluating its magnitude globally and in different regions and settings suggests that some regional variations might exist.
About: This article is published in European Journal of Obstetrics & Gynecology and Reproductive Biology.The article was published on 2013-09-01. It has received 905 citations till now.
Citations
More filters
TL;DR: There is a halving in the risk of developing severe hypertension associated with the use of antihypertensive drug(s) and other outcomes were only reported by a small proportion of studies, and there were no clear differences in any other outcomes.
Abstract: Background
Mild to moderate hypertension during pregnancy is common. Antihypertensive drugs are often used in the belief that lowering blood pressure will prevent progression to more severe disease, and thereby improve the outcome.
Objectives
To assess the effects of antihypertensive drug treatments for women with mild to moderate hypertension during pregnancy.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 April 2013) and reference lists of retrieved studies.
Selection criteria
All randomised trials evaluating any antihypertensive drug treatment for mild to moderate hypertension during pregnancy defined, whenever possible, as systolic blood pressure 140 to 169 mmHg and diastolic blood pressure 90 to 109 mmHg. Comparisons were of one or more antihypertensive drug(s) with placebo, with no antihypertensive drug, or with another antihypertensive drug, and where treatment was planned to continue for at least seven days.
Data collection and analysis
Two review authors independently extracted data.
Main results
Forty-nine trials (4723 women) were included. Twenty-nine trials compared an antihypertensive drug with placebo/no antihypertensive drug (3350 women). There is a halving in the risk of developing severe hypertension associated with the use of antihypertensive drug(s) (20 trials, 2558 women; risk ratio (RR) 0.49; 95% confidence interval (CI) 0.40 to 0.60; risk difference (RD) -0.10 (-0.13 to -0.07); number needed to treat to harm (NNTH) 10 (8 to 13)) but little evidence of a difference in the risk of pre-eclampsia (23 trials, 2851 women; RR 0.93; 95% CI 0.80 to 1.08). Similarly, there is no clear effect on the risk of the baby dying (27 trials, 3230 women; RR 0.71; 95% CI 0.49 to 1.02), preterm birth (15 trials, 2141 women; RR 0.96; 95% CI 0.85 to 1.10), or small-for-gestational-age babies (20 trials, 2586 women; RR 0.97; 95% CI 0.80 to 1.17). There were no clear differences in any other outcomes.
Twenty-two trials (1723 women) compared one antihypertensive drug with another. Alternative drugs seem better than methyldopa for reducing the risk of severe hypertension (11 trials, 638 women; RR (random-effects) 0.54; 95% CI 0.30 to 0.95; RD -0.11 (-0.20 to -0.02); NNTH 7 (5 to 69)). There is also a reduction in the overall risk of developing proteinuria/pre-eclampsia when beta blockers and calcium channel blockers considered together are compared with methyldopa (11 trials, 997 women; RR 0.73; 95% CI 0.54 to 0.99). However, the effect on both severe hypertension and proteinuria is not seen in the individual drugs. Other outcomes were only reported by a small proportion of studies, and there were no clear differences.
Authors' conclusions
It remains unclear whether antihypertensive drug therapy for mild to moderate hypertension during pregnancy is worthwhile.
614 citations
TL;DR: Recent research has focused on placental-uterine interactions in early pregnancy, and the aim now is to translate these findings into new ways to predict, prevent, and treat pre-eclampsia.
Abstract: Pre-eclampsia is a common disorder that particularly affects first pregnancies. The clinical presentation is highly variable but hypertension and proteinuria are usually seen. These systemic signs arise from soluble factors released from the placenta as a result of a response to stress of syncytiotrophoblast. There are two sub-types: early and late onset pre-eclampsia, with others almost certainly yet to be identified. Early onset pre-eclampsia arises owing to defective placentation, whilst late onset pre-eclampsia may center around interactions between normal senescence of the placenta and a maternal genetic predisposition to cardiovascular and metabolic disease. The causes, placental and maternal, vary among individuals. Recent research has focused on placental-uterine interactions in early pregnancy. The aim now is to translate these findings into new ways to predict, prevent, and treat pre-eclampsia.
587 citations
TL;DR: The pathogenic role of antiangiogenic proteins released by the placenta in the development of pre-eclampsia is discussed and novel therapeutic strategies directed at restoring the angiogenic imbalance observed during pre- eClampsia are reviewed.
Abstract: Pre-eclampsia is a complication of pregnancy that is associated with substantial maternal and fetal morbidity and mortality. The disease presents with new-onset hypertension and often proteinuria in the mother, which can progress to multi-organ dysfunction, including hepatic, renal and cerebral disease, if the fetus and placenta are not delivered. Maternal endothelial dysfunction due to circulating factors of fetal origin from the placenta is a hallmark of pre-eclampsia. Risk factors for the disease include maternal comorbidities, such as chronic kidney disease, hypertension and obesity; a family history of pre-eclampsia, nulliparity or multiple pregnancies; and previous pre-eclampsia or intrauterine fetal growth restriction. In the past decade, the discovery and characterization of novel antiangiogenic pathways have been particularly impactful both in increasing understanding of the disease pathophysiology and in directing predictive and therapeutic efforts. In this Review, we discuss the pathogenic role of antiangiogenic proteins released by the placenta in the development of pre-eclampsia and review novel therapeutic strategies directed at restoring the angiogenic imbalance observed during pre-eclampsia. We also highlight other notable advances in the field, including the identification of long-term maternal and fetal risks conferred by pre-eclampsia.
539 citations
TL;DR: To assess the incidence of hypertensive disorders of pregnancy and related severe complications, identify other associated factors and compare maternal and perinatal outcomes in women with and without these conditions.
382 citations
TL;DR: Women with early-onset and late-onsetset preeclampsia have significantly higher rates of specific maternal morbidity compared with women without early-onsonet andLate-ONSet disease.
226 citations
Cites background from "Global and regional estimates of pr..."
...In industrialized countries, the incidence of preeclampsia is approximately 3–5 per 100 births.(4,11) Most industrialized countries have experienced a decline in the incidence of preeclampsia over the past decade, although isolated studies report a temporal increase in frequency....
[...]
References
More filters
Book•
01 Jan 1993TL;DR: This article presents bootstrap methods for estimation, using simple arguments, with Minitab macros for implementing these methods, as well as some examples of how these methods could be used for estimation purposes.
Abstract: This article presents bootstrap methods for estimation, using simple arguments. Minitab macros for implementing these methods are given.
37,183 citations
TL;DR: Haemorrhage and hypertensive disorders are major contributors to maternal deaths in developing countries and these data should inform evidence-based reproductive health-care policies and programmes at regional and national levels.
3,593 citations
"Global and regional estimates of pr..." refers background or methods in this paper
...In Latin America and the Caribbean HDP represent the highest cause of death, being the second cause in developed countries [1]....
[...]
...These were available for 193 countries [1]....
[...]
...They account for nearly 18% of all maternal deaths worldwide, with an estimated 62,000 to 77,000 deaths per year [1]....
[...]
...We used theWorld Health Organization (WHO) Systematic Review of Maternal Mortality and Morbidity Project Protocol as a template [1,6], considering the same criteria for screening, identification and selection of studies to all potentially eligible papers published during the period 2002–2010....
[...]
2,562 citations
01 Jan 2012
TL;DR: The MDG 5 Target 5A calls for the reduction of maternal mortality ratio by three quarters between 1990 and 2015 as mentioned in this paper, which has been a challenge to assess the extent of progress due to the lack of reliable and accurate maternal mortality data.
Abstract: Millennium Development Goal (MDG) 5 Target 5A calls for the reduction of maternal mortality ratio by three quarters between 1990 and 2015. It has been a challenge to assess the extent of progress due to the lack of reliable and accurate maternal mortality data -- particularly in developing-country settings where maternal mortality is high. As part of ongoing efforts the WHO UNICEF UNFPA and The World Bank updated estimates of maternal mortality for the years 1990 1995 2000 2005 and 2010.
663 citations
TL;DR: Magnesium sulphate more than halves the risk of eclampsia, and probably reduces maternal death, and there is no clear effect on outcome after discharge from hospital.
Abstract: Background
Eclampsia, the occurrence of a seizure (fit) in association with pre-eclampsia, is rare but potentially life-threatening. Magnesium sulphate is the drug of choice for treating eclampsia. This review assesses its use for preventing eclampsia.
Objectives
To assess the effects of magnesium sulphate, and other anticonvulsants, for prevention of eclampsia.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (4 June 2010), and the Cochrane Central Register of Controlled Trials Register (The Cochrane Library 2010, Issue 3).
Selection criteria
Randomised trials comparing anticonvulsants with placebo or no anticonvulsant, or comparisons of different drugs, for pre-eclampsia.
Data collection and analysis
Two authors assessed trial quality and extracted data independently.
Main results
We included 15 trials. Six (11,444 women) compared magnesium sulphate with placebo or no anticonvulsant: magnesium sulphate more than a halved the risk of eclampsia (risk ratio (RR) 0.41, 95% confidence interval (CI) 0.29 to 0.58; number needed to treat for an additional beneficial outcome (NNTB) 100, 95% CI 50 to 100), with a non-significant reduction in maternal death (RR 0.54, 95% CI 0.26 to 1.10) but no clear difference in serious maternal morbidity (RR 1.08, 95% CI 0.89 to 1.32). It reduced the risk of placental abruption (RR 0.64, 95% CI 0.50 to 0.83; NNTB 100, 95% CI 50 to 1000), and increased caesarean section (RR 1.05, 95% CI 1.01 to 1.10). There was no clear difference in stillbirth or neonatal death (RR 1.04, 95% CI 0.93 to 1.15). Side effects, primarily flushing, were more common with magnesium sulphate (24% versus 5%; RR 5.26, 95% CI 4.59 to 6.03; number need to treat for an additional harmful outcome (NNTH) 6, 95% CI 5 to 6).
Follow-up was reported by one trial comparing magnesium sulphate with placebo: for 3375 women there was no clear difference in death (RR 1.79, 95% CI 0.71 to 4.53) or morbidity potentially related to pre-eclampsia (RR 0.84, 95% CI 0.55 to 1.26) (median follow-up 26 months); for 3283 children exposed in utero there was no clear difference in death (RR 1.02, 95% CI 0.57 to 1.84) or neurosensory disability (RR 0.77, 95% CI 0.38 to 1.58) at age 18 months.
Magnesium sulphate reduced eclampsia compared to phenytoin (three trials, 2291 women; RR 0.08, 95% CI 0.01 to 0.60) and nimodipine (one trial, 1650 women; RR 0.33, 95% CI 0.14 to 0.77).
Authors' conclusions
Magnesium sulphate more than halves the risk of eclampsia, and probably reduces maternal death. There is no clear effect on outcome after discharge from hospital. A quarter of women report side effects with magnesium sulphate.
407 citations