Prediction and primary prevention of pre-eclampsia

Shakila Thangaratinam, Josie Langenveld, Ben W. Mol, Khalid S. Khan

Research output: Contribution to journalReview article

33 Citations (Scopus)

Abstract

Pre-eclampsia is associated with increased maternal and perinatal mortality and morbidity. Early recognition of women at risk of pre-eclampsia will enable the identification of high-risk women who may benefit from enhanced surveillance and prophylaxis. In this chapter, we summarise the accuracy of various tests used to predict the onset of pre-eclampsia and the effectiveness of preventative treatment. The tests used to predict pre-eclampsia include clinical history, examination findings, laboratory and haemodynamic tests. In general, tests in early pregnancy for predicting later development of pre-eclampsia have better specificity than sensitivity, as Body Mass Index greater than 34, alpha-fetoprotein, fibronectin and uterine artery Doppler (bilateral notching) all have specificities above 90%. Only uterine artery Doppler resistance index and combinations of indices have a sensitivity of over 60%. Test such as kallikreinuria not used in clinical practice, has shown high sensitivity above 80%, without compromising specificity, and require further investigation. None of the tests are sufficiently accurate to recommend them for routine use in clinical practice. The various treatment options for preventing pre-eclampsia include pharmacological agents, dietary supplementation and lifestyle modification. Antiplatelet agents, primarily low-dose aspirin, reduce the risk of pre-eclampsia by 10% (RR 0.90, 95% CI 0.84 to 0.97). Calcium effectively prevents pre-eclampsia (RR 0.45, 95% CI 0.31 to 0.65); the beneficial effect being observed in the high-risk group (RR 0.22; 95% CI 0.12 to 0.42) and in the group with low nutritional calcium intake (RR 0.36, 95% CI 0.20 to 0.65). Pharmacological agents, such as low molecular weight heparin, progesterone, nitric oxide donors, anti-hypertensive medication and diuretics are not effective in preventing pre-eclampsia. Dietary supplements, such as magnesium, anti-oxidants, marine oils and folic acid, do not reduce the incidence of pre-eclampsia. Evidence is lacking to support lifestyle preventative interventions for pre-eclampsia, such as rest, exercise and reduced dietary salt intake.

LanguageEnglish
Pages419-433
Number of pages15
JournalBest Practice and Research: Clinical Obstetrics and Gynaecology
Volume25
Issue number4
DOIs
Publication statusPublished - 1 Jan 2011

Keywords

  • complications
  • pre-eclampsia
  • prediction
  • prevention
  • screening

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

Thangaratinam, Shakila ; Langenveld, Josie ; Mol, Ben W. ; Khan, Khalid S. / Prediction and primary prevention of pre-eclampsia. In: Best Practice and Research: Clinical Obstetrics and Gynaecology. 2011 ; Vol. 25, No. 4. pp. 419-433.
@article{b873063dbb2542a3a89d72f151f0befa,
title = "Prediction and primary prevention of pre-eclampsia",
abstract = "Pre-eclampsia is associated with increased maternal and perinatal mortality and morbidity. Early recognition of women at risk of pre-eclampsia will enable the identification of high-risk women who may benefit from enhanced surveillance and prophylaxis. In this chapter, we summarise the accuracy of various tests used to predict the onset of pre-eclampsia and the effectiveness of preventative treatment. The tests used to predict pre-eclampsia include clinical history, examination findings, laboratory and haemodynamic tests. In general, tests in early pregnancy for predicting later development of pre-eclampsia have better specificity than sensitivity, as Body Mass Index greater than 34, alpha-fetoprotein, fibronectin and uterine artery Doppler (bilateral notching) all have specificities above 90{\%}. Only uterine artery Doppler resistance index and combinations of indices have a sensitivity of over 60{\%}. Test such as kallikreinuria not used in clinical practice, has shown high sensitivity above 80{\%}, without compromising specificity, and require further investigation. None of the tests are sufficiently accurate to recommend them for routine use in clinical practice. The various treatment options for preventing pre-eclampsia include pharmacological agents, dietary supplementation and lifestyle modification. Antiplatelet agents, primarily low-dose aspirin, reduce the risk of pre-eclampsia by 10{\%} (RR 0.90, 95{\%} CI 0.84 to 0.97). Calcium effectively prevents pre-eclampsia (RR 0.45, 95{\%} CI 0.31 to 0.65); the beneficial effect being observed in the high-risk group (RR 0.22; 95{\%} CI 0.12 to 0.42) and in the group with low nutritional calcium intake (RR 0.36, 95{\%} CI 0.20 to 0.65). Pharmacological agents, such as low molecular weight heparin, progesterone, nitric oxide donors, anti-hypertensive medication and diuretics are not effective in preventing pre-eclampsia. Dietary supplements, such as magnesium, anti-oxidants, marine oils and folic acid, do not reduce the incidence of pre-eclampsia. Evidence is lacking to support lifestyle preventative interventions for pre-eclampsia, such as rest, exercise and reduced dietary salt intake.",
keywords = "complications, pre-eclampsia, prediction, prevention, screening",
author = "Shakila Thangaratinam and Josie Langenveld and Mol, {Ben W.} and Khan, {Khalid S.}",
year = "2011",
month = "1",
day = "1",
doi = "10.1016/j.bpobgyn.2011.02.008",
language = "English",
volume = "25",
pages = "419--433",
journal = "Best Practice and Research: Clinical Obstetrics and Gynaecology",
issn = "1521-6934",
publisher = "Bailliere Tindall Ltd",
number = "4",

}

Prediction and primary prevention of pre-eclampsia. / Thangaratinam, Shakila; Langenveld, Josie; Mol, Ben W.; Khan, Khalid S.

In: Best Practice and Research: Clinical Obstetrics and Gynaecology, Vol. 25, No. 4, 01.01.2011, p. 419-433.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Prediction and primary prevention of pre-eclampsia

AU - Thangaratinam, Shakila

AU - Langenveld, Josie

AU - Mol, Ben W.

AU - Khan, Khalid S.

PY - 2011/1/1

Y1 - 2011/1/1

N2 - Pre-eclampsia is associated with increased maternal and perinatal mortality and morbidity. Early recognition of women at risk of pre-eclampsia will enable the identification of high-risk women who may benefit from enhanced surveillance and prophylaxis. In this chapter, we summarise the accuracy of various tests used to predict the onset of pre-eclampsia and the effectiveness of preventative treatment. The tests used to predict pre-eclampsia include clinical history, examination findings, laboratory and haemodynamic tests. In general, tests in early pregnancy for predicting later development of pre-eclampsia have better specificity than sensitivity, as Body Mass Index greater than 34, alpha-fetoprotein, fibronectin and uterine artery Doppler (bilateral notching) all have specificities above 90%. Only uterine artery Doppler resistance index and combinations of indices have a sensitivity of over 60%. Test such as kallikreinuria not used in clinical practice, has shown high sensitivity above 80%, without compromising specificity, and require further investigation. None of the tests are sufficiently accurate to recommend them for routine use in clinical practice. The various treatment options for preventing pre-eclampsia include pharmacological agents, dietary supplementation and lifestyle modification. Antiplatelet agents, primarily low-dose aspirin, reduce the risk of pre-eclampsia by 10% (RR 0.90, 95% CI 0.84 to 0.97). Calcium effectively prevents pre-eclampsia (RR 0.45, 95% CI 0.31 to 0.65); the beneficial effect being observed in the high-risk group (RR 0.22; 95% CI 0.12 to 0.42) and in the group with low nutritional calcium intake (RR 0.36, 95% CI 0.20 to 0.65). Pharmacological agents, such as low molecular weight heparin, progesterone, nitric oxide donors, anti-hypertensive medication and diuretics are not effective in preventing pre-eclampsia. Dietary supplements, such as magnesium, anti-oxidants, marine oils and folic acid, do not reduce the incidence of pre-eclampsia. Evidence is lacking to support lifestyle preventative interventions for pre-eclampsia, such as rest, exercise and reduced dietary salt intake.

AB - Pre-eclampsia is associated with increased maternal and perinatal mortality and morbidity. Early recognition of women at risk of pre-eclampsia will enable the identification of high-risk women who may benefit from enhanced surveillance and prophylaxis. In this chapter, we summarise the accuracy of various tests used to predict the onset of pre-eclampsia and the effectiveness of preventative treatment. The tests used to predict pre-eclampsia include clinical history, examination findings, laboratory and haemodynamic tests. In general, tests in early pregnancy for predicting later development of pre-eclampsia have better specificity than sensitivity, as Body Mass Index greater than 34, alpha-fetoprotein, fibronectin and uterine artery Doppler (bilateral notching) all have specificities above 90%. Only uterine artery Doppler resistance index and combinations of indices have a sensitivity of over 60%. Test such as kallikreinuria not used in clinical practice, has shown high sensitivity above 80%, without compromising specificity, and require further investigation. None of the tests are sufficiently accurate to recommend them for routine use in clinical practice. The various treatment options for preventing pre-eclampsia include pharmacological agents, dietary supplementation and lifestyle modification. Antiplatelet agents, primarily low-dose aspirin, reduce the risk of pre-eclampsia by 10% (RR 0.90, 95% CI 0.84 to 0.97). Calcium effectively prevents pre-eclampsia (RR 0.45, 95% CI 0.31 to 0.65); the beneficial effect being observed in the high-risk group (RR 0.22; 95% CI 0.12 to 0.42) and in the group with low nutritional calcium intake (RR 0.36, 95% CI 0.20 to 0.65). Pharmacological agents, such as low molecular weight heparin, progesterone, nitric oxide donors, anti-hypertensive medication and diuretics are not effective in preventing pre-eclampsia. Dietary supplements, such as magnesium, anti-oxidants, marine oils and folic acid, do not reduce the incidence of pre-eclampsia. Evidence is lacking to support lifestyle preventative interventions for pre-eclampsia, such as rest, exercise and reduced dietary salt intake.

KW - complications

KW - pre-eclampsia

KW - prediction

KW - prevention

KW - screening

UR - http://www.scopus.com/inward/record.url?scp=79960461402&partnerID=8YFLogxK

U2 - 10.1016/j.bpobgyn.2011.02.008

DO - 10.1016/j.bpobgyn.2011.02.008

M3 - Review article

VL - 25

SP - 419

EP - 433

JO - Best Practice and Research: Clinical Obstetrics and Gynaecology

T2 - Best Practice and Research: Clinical Obstetrics and Gynaecology

JF - Best Practice and Research: Clinical Obstetrics and Gynaecology

SN - 1521-6934

IS - 4

ER -