Cardiovascular Medicine Book

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Preeclampsia Prevention

Aka: Preeclampsia Prevention, Preeclampsia Prophylaxis, PIH Prophylaxis
  1. Indications: Preeclampsia risk factors
    1. Preeclampsia in prior pregnancy
    2. Chronic Hypertension
    3. Diabetes Mellitus
    4. Renal disease
    5. Advanced maternal age
  2. Management: Calcium Supplementation 1 gram per day
    1. Lowers Preeclampsia risk
    2. Lowers Blood Pressure
      1. Systolic lowered 5.4 mmHg
      2. Diastolic lowered 3.4 mmhg
    3. Reference
      1. Bucher HC (1996) JAMA 275:1113-7
  3. Management: Aspirin 81 mg/day
    1. Benefits
      1. Prevents Pregnancy Induced Hypertension
      2. Prevents Intrauterine Growth Retardation
    2. Greatest benefit if highest risk factors present
      1. Prior Severe Preeclampsia
      2. Diabetes Mellitus
      3. Chronic Hypertension
      4. Renal disease
      5. Autoimmune disease
    3. Efficacy: Number Needed to Treat (NNT) to prevent one case of Preeclampsia
      1. NNT: 69 (overall)
      2. NNT: 18 (if highest risk factors present)
    4. References
      1. Coomarasamy (2003) Obstet Gynecol 101:1319-32
  4. Management: Agents to avoid due to low efficacy
    1. Avoid routine Magnesium Supplementation
    2. Avoid routine Omega-3 Fatty Acid Supplementation
    3. Avoid antioxidant vitamin supplementation
  5. References
    1. Fontaine (2000) in ALSO, B:1-36
    2. Sibai in Gabbe (2002) Obstetrics, p. 945-74
    3. (2000) Am J Obstet Gynecol 183(1):S1-22
    4. Zamorski (2001) Clin Fam Pract 3:329-47

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