Materiały źródłowe

• #1 Prevention of Preeclampsia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8236336/

  Preeclampsia is an obstetric disorder that affects 38% of pregnant women and remains a leading cause of short- and long-term neonatal and maternal morbidity and mortality. Professional societies recommend the use of low dose aspirin to prevent preeclampsia in high-risk women. […] The only current cure for preeclampsia is delivery of the placenta and fetus, however this is commonly associated with iatrogenic preterm delivery. In an effort to prevent that and improve outcomes for mothers, children and adult offspring, research efforts are currently focused not only on treatment of preeclampsia, but on ways to prevent preeclampsia from occurring. […] Aspirin is currently the only medication recommended for the prevention of preeclampsia. […] Currently, both the U.S. Preventive Services Task Force (USPSTF) and the American College of Obstetricians and Gynecologists (ACOG) recommend aspirin use for preeclampsia prevention for women at high risk for developing the disease (e.g. those with chronic hypertension, pre-gestational diabetes mellitus, multifetal gestation, renal disease, and autoimmune disease, etc), and to be started between 12 and 28 weeks gestation and continued until delivery.

• #1 Low-Dose Aspirin Use for the Prevention of Preeclampsia and Related Morbidity and Mortality | ACOG

  https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/12/low-dose-aspirin-use-for-the-prevention-of-preeclampsia-and-related-morbidity-and-mortality

  Low-dose aspirin has been used during pregnancy most commonly to prevent or delay the onset of preeclampsia. The previous recommendation from the American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal-Fetal Medicine (SMFM), and the U.S. Preventive Services Task Force (USPSTF) has been for low-dose aspirin (81 mg/d) prophylaxis after 12 weeks of gestation in pregnant individuals at high risk of preeclampsia and suggested low-dose aspirin prophylaxis in pregnant individuals with more than one moderate-risk factor. ACOG and SMFM also have provided more detailed information around timing, recommending that low-dose aspirin be initiated between 12 weeks and 28 weeks of gestation (optimally before 16 weeks) and continued daily until delivery. […] In September 2021, the USPSTF published updated recommendations on aspirin use to prevent preeclampsia and related morbidity and mortality. The primary USPSTF recommendation remains largely unchanged: prescribe low-dose (81 mg/d) aspirin after 12 weeks of gestation to individuals who are at high risk for preeclampsia (Grade B). However, the USPSTF provided updated guidance regarding moderate-risk factors. Specifically, the USPSTF now recommends low-dose aspirin for individuals with more than one moderate-risk factor.

• #2 Preeclampsia Treatment & Management: Approach Considerations, Prehospital Treatment, Care in Preeclampsia Without Severe Features

  https://emedicine.medscape.com/article/1476919-treatment

  Efforts to prevent preeclampsia have been disappointing. […] A systematic review of 14 trials using low-dose aspirin (60-150 mg/d) in women with risk factors for preeclampsia concluded that aspirin reduced the risk of preeclampsia and perinatal death, although it did not significantly affect birth weight or the risk of abruption. […] For women with risk factors for preeclampsia, starting low-dose aspirin (commonly, 1 tablet of baby aspirin per day), beginning at 12-14 weeks’ gestation, is reasonable. The safety of low-dose aspirin use in the second and third trimesters is well established. […] A 2016 ACOG Practice Advisory upheld the recommendation for the possible use of low-dose aspirin (81 mg/day), introduced between 12 and 28 weeks of gestation, to prevent preeclampsia in women who are at high risk.

• #2 Prevention of preeclampsia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5127661/

  Preeclampsia is a common complication of pregnancy that is associated with an increased risk of maternal and neonatal morbidity and mortality. Currently, delivery is the only cure for preeclampsia; therefore, effective prevention and treatment options for this condition are sorely needed. […] As treatment and screening options are limited, therapies that prevent preeclampsia, delay the onset of the disorder, or decrease disease severity would be beneficial. One of the best-studied agents for the prevention of preeclampsia is low-dose aspirin. The US Preventive Services Task Force (USPSTF) and the American College of Obstetricians and Gynecologists (ACOG) currently recommend the use of low-dose aspirin for the prevention of preeclampsia in high-risk women. […] In addition to low-dose aspirin, other studied modalities for the prevention or treatment of preeclampsia include antioxidants (vitamins C and E), calcium supplements, fish oil, nitric oxide supplements, nitric oxide donors, folic acid, weight loss, antihypertensive agents, and physical activity.

• #3

  https://www.who.int/publications/i/item/9789240081130

  In women identified as being at increased risk of developing pre-eclampsia, prophylaxis with daily low-dose aspirin can reduce the risk of pre-eclampsia by 10-20%. […] For women living in areas with low calcium intake, high-dose calcium supplementation can reduce the risk of developing pre-eclampsia by more than 50%. […] The purpose of this target product profile (TPP) is to provide guidance to product developers and funders about key characteristics and desired attributes of preventive agents that should be administered to pregnant women identified as being at increased risk of developing pre-eclampsia, accompanied by monitoring for the development of pre-eclampsia. […] This TPP outlines both minimal and preferred characteristics of a medicine that should: prevent the development of pre-eclampsia; have a good safety profile during pregnancy; be commenced early in pregnancy (before 20 weeks gestation) and continued throughout pregnancy and postpartum as required; be suitable for administration in any health care setting where pregnant women receive antenatal care, including in low- and middle-income countries.

• #4 Preventing pre-eclampsia – Monash Women’s

  https://monashwomens.org/health-information/first-trimester-pregnancy/preventing-pre-eclampsia/

  Recent research has shown that several major pregnancy complications, including pre-eclampsia, can be lessened or prevented by treatment from the first trimester. […] Pre-eclampsia is a particularly exciting area of prevention as it is a serious condition that cannot be cured except by birth, has significant risks for both mother and baby, and is now known to be safely reduced by around 60% with a simple daily dose of aspirin (at night). […] Aspirin is started early to help the placenta grow and continue to develop optimally. This is before 16 weeks although there is a lesser degree of benefit if started later. […] In short, yes. A very large trial (ASPRE) was able to demonstrate the safety of aspirin at 150mg in pregnant women for mothers and their babies and that it successfully reduced the incidence of severe early pre-eclampsia, the kind most associated with harm to mother and baby.

• #5 Preventing pre-eclampsia – Monash Women’s

  https://monashwomens.org/health-information/first-trimester-pregnancy/preventing-pre-eclampsia/

  There are other things you can do to reduce your chance of developing pre-eclampsia. These include maintaining a healthy BMI, keeping any chronic medical conditions well controlled and taking a calcium supplement or having a calcium rich diet. […] Interestingly, there is good data which shows that aspirin taken at night is much more effective than aspirin taken in the morning at preventing pre-eclampsia, even when all else is equivalent.

• #6 Low-Dose Aspirin Use for the Prevention of Preeclampsia and Related Morbidity and Mortality | ACOG

  https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/12/low-dose-aspirin-use-for-the-prevention-of-preeclampsia-and-related-morbidity-and-mortality

  Based on the updated USPSTF guidance and its supporting evidence, ACOG and SMFM are revising their recommendation regarding low-dose aspirin prophylaxis for the prevention of preeclampsia. Low-dose aspirin (81 mg/d) prophylaxis is recommended for pregnant individuals at high risk of preeclampsia with one or more of the following risk factors: History of preeclampsia, especially when accompanied by an adverse outcome; Multifetal gestation; Chronic hypertension; Pregestational type 1 or 2 diabetes; Kidney disease; Autoimmune disease (ie, systemic lupus erythematous, antiphospholipid syndrome); Combinations of multiple moderate-risk factors. […] These risk factors are consistently associated with the greatest risk for preeclampsia. Preeclampsia incidence would likely be at least 8% in a population of pregnant individuals having one of these risk factors.

• #7 Preeclampsia Treatment & Management: Approach Considerations, Prehospital Treatment, Care in Preeclampsia Without Severe Features

  https://emedicine.medscape.com/article/1476919-treatment

  Low-dose aspirin (81 mg/d) prophylaxis is recommended for pregnant individuals at high risk of preeclampsia with one or more of the following risk factors: History of preeclampsia, especially when accompanied by an adverse outcome; Multifetal gestation; Chronic hypertension; Pregestational type 1 or 2 diabetes; Kidney disease; Autoimmune disease (ie, systemic lupus erythematous, antiphospholipid syndrome); Combinations of multiple moderate-risk factors. […] Low-dose aspirin (81 mg/d) prophylaxis is also recommended for pregnant individuals with more than one of the following moderate risk factors: Nulliparity; Obesity (ie, body mass index 30); Family history of preeclampsia (ie, mother or sister); Black race (as a proxy for underlying racism); Lower income; Age 35 years or older; Personal history factors (eg, low birth weight or small for gestational age, previous adverse pregnancy outcome, 10-year pregnancy interval); In vitro fertilization.

• #8 Low-dose aspirin in pregnancy to prevent pre-eclampsia – Overview | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/low-dose-aspirin-in-pregnancy-to-prevent-pre-eclampsia

  Pre-eclampsia is a high-blood pressure condition that usually happens towards the end of pregnancy. […] If you are at greater risk of pre-eclampsia, we recommend that you take a low dose of aspirin every day. There is evidence that taking aspirin during pregnancy reduces the risk of pre-eclampsia. […] We ask you to take low-dose aspirin for the rest of your pregnancy if you have 1 high risk factor or 2 moderate risk factors. […] You’ll have low-dose aspirin if you have 1 or more high risk factors, which include: high blood pressure, before or during pregnancy, problems in previous pregnancies, chronic kidney disease, any auto-immune disease, such as antiphospholipid syndrome (APS), diabetes. […] You’ll have low-dose aspirin if you have 2 or more moderate risk factors, which include: this being your first pregnancy, 40 years of age and over, obesity with a body mass index (BMI) of more than 35, expecting twins (or multiple births), having a family history of pre-eclampsia.

• #9 Aspirin Use to Prevent Preeclampsia: USPSTF Recommendation

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2021/09/28/19/45/Aspirin-Use-to-Prevent-Preeclampsia

  Aspirin Use to Prevent Preeclampsia: USPSTF Recommendation […] The following are key points to remember from the US Preventive Services Task Force (USPSTF) recommendation statement on the use of aspirin to prevent preeclampsia and related morbidity and mortality: […] Preeclampsia is a complication in approximately 4% of pregnancies in the United States, and accounts for 6% of preterm births and 19% of medically indicated preterm births in the United States. […] […] The USPSTF commissioned a systematic review to evaluate the effectiveness of low-dose aspirin to prevent preeclampsia, which strengthened their 2014 recommendation. […] Low-dose aspirin reduces the risk of preeclampsia, preterm birth, small for gestational age/intrauterine growth restriction, and perinatal mortality in pregnant persons with risk factors for preeclampsia.

• #10 Low-Dose Aspirin Use for the Prevention of Preeclampsia and Related Morbidity and Mortality | ACOG

  https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/12/low-dose-aspirin-use-for-the-prevention-of-preeclampsia-and-related-morbidity-and-mortality

  Additionally, low-dose aspirin can be considered if the patient has one or more of the following moderate-risk factors: Black race (as a proxy for underlying racism), or lower income. When recommended, low-dose aspirin should be initiated between 12 weeks and 28 weeks of gestation (optimally before 16 weeks) and continued daily until delivery. […] Evidence supports the use of a risk-based approach to determine whether low-dose aspirin should be offered to a pregnant individual. It is therefore imperative that obstetriciangynecologists and other obstetric clinicians implement adequate screening processes to determine the appropriate risk category for a pregnant individual. However, for some institutions and practices, the majority of patients may be at high or moderate risk for preeclampsia and would therefore be candidates for low-dose aspirin prophylaxis. In these instances, universal implementation (eg, offering low-dose aspirin to all patients within such practices or institutions) may be medically reasonable.

• #11 Aspirin Use to Prevent Preeclampsia: USPSTF Recommendation

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2021/09/28/19/45/Aspirin-Use-to-Prevent-Preeclampsia

  High-risk factors for preeclampsia include: history of preeclampsia (especially when accompanied by an adverse outcome), multifetal gestation, chronic hypertension, pregestational type 1 or 2 diabetes, kidney disease, and autoimmune disease (i.e., systemic lupus erythematosus, antiphospholipid syndrome). If one or more of these high-risk factors are present, the USPSTF recommends low-dose aspirin. […] Moderate-risk factors for preeclampsia include: nulliparity, obesity (i.e., body mass index 30 kg/m2), family history of preeclampsia (i.e., mother or sister), Black persons (due to social, rather than biological, factors), lower income, age 35 years or older, personal history factors (e.g., low birth weight or small for gestational age, previous adverse pregnancy outcome, 10-year pregnancy interval), or in vitro conception. If two or more of these moderate-risk factors are present, the USPSTF recommends low-dose aspirin (may consider low-dose aspirin if one of these risk factors is present).

• #12 Preeclampsia Prevention

  https://mobile.fpnotebook.com/CV/OB/PrclmpsPrvntn.htm

  Preeclampsia Prevention, Preeclampsia Prophylaxis, PIH Prophylaxis, HELLP Prevention, Pregnancy Induced Hypertension Prophylaxis […] Aspirin 81 mg/day […] ACOG and USPTF Indications (to start in first trimester) […] One Preeclampsia high risk factor or two moderate risk factors (sere above) […] This replaces the older, more limited criteria focused on prior Preeclampsia in pregnancy […] Protocol […] Aspirin 81 mg orally daily […] Start at 12 to 28 weeks (preferably by 16 weeks gestation) […] Continue Aspirin until delivery […] Efficacy: Benefits […] Prevents Pregnancy Induced Hypertension […] Prevents Intrauterine Growth Retardation […] Efficacy: Number Needed to Treat (NNT) to prevent one case of Preeclampsia […] NNT: 69 (overall) […] NNT: 18 (if highest risk factors present)

• #13 Recommendation: Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: Preventive Medication | United States Preventive Services Taskforce

  https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/low-dose-aspirin-use-for-the-prevention-of-morbidity-and-mortality-from-preeclampsia-preventive-medication

  Effective dosages of low-dose aspirin range from 60 to 150 mg/d. […] Low-dose aspirin use should be initiated after 12 weeks of gestation. […] Pregnant persons with 1 or more high-risk factors should receive low-dose aspirin. Pregnant persons with moderate-risk factors may also benefit from low-dose aspirin. […] The USPSTF has also issued recommendations for numerous conditions in pregnant persons, including screening for preeclampsia and folic acid supplementation to prevent neural tube defects. […] In the 2014 recommendation, the USPSTF recommended the use of low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of gestation in persons at high risk for preeclampsia (B recommendation). […] The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine recommend low-dose aspirin (81 mg/d) prophylaxis for persons at high risk of preeclampsia; the regimen should be initiated between 12 and 28 weeks of gestation (optimally before 16 weeks) and continued daily until delivery.

• #14 Optimal Aspirin Dosage for the Prevention of Preeclampsia and Other Adverse Pregnancy Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

  https://www.mdpi.com/2077-0383/14/7/2134

  Optimal Aspirin Dosage for the Prevention of Preeclampsia and Other Adverse Pregnancy Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials […] Background/Objectives: This systematic review and meta-analysis aimed to determine the effectiveness of different aspirin dosages in preventing preeclampsia and its effect on other pregnancy-associated conditions. […] Results: Based on the analysis of 31 studies involving 28,318 pregnancies and 20 studies involving 26,551 pregnancies, the early initiation of aspirin significantly reduced the overall incidence of preeclampsia (RR = 0.63, CI: 0.47–0.84) and perinatal death risk (RR = 0.82, CI: 0.72–0.93), respectively. […] Conclusions: Early-initiated aspirin prophylaxis is effective in preventing preeclampsia, without raising the incidence of placental abruption or increasing the amount of peripartum bleeding. […] Aspirin is a widely available and affordable medication with the potential to safely help pregnant women and neonates during pregnancy by preventing preeclampsia and its complications. […] The timing of initiation for preeclampsia prevention is suggested at ≥12 weeks of gestation and ideally before 16 weeks. […] The recommendation delivered by The International Federation of Gynecology and Obstetrics (FIGO) in 2020 also suggests aspirin prophylaxis commencing at 11–14 weeks plus 6 days of gestation at a dose of ~150 mg until 36 weeks of gestation, when delivery occurs, or when preeclampsia is diagnosed. […] In correlation with prior meta-analyses, we found that aspirin started before the 20th week significantly reduced the risk of preeclampsia and perinatal death in both low- and high-risk pregnancies. […] Despite the clear benefits of early initiation, our findings indicate no significant dose–response relationship, reinforcing the idea that lower doses may be equally effective in preeclampsia prevention when administered at the optimal time. […] We suggest aspirin prophylaxis at a dose of 81 g to 150 mg for high-risk pregnancies with the initiation before 16 but not earlier than 11 weeks of gestation, until 36 weeks of gestation, when delivery occurs, or when preeclampsia is diagnosed. […]

• #15 Low-dose aspirin in pregnancy to prevent pre-eclampsia – Overview | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/low-dose-aspirin-in-pregnancy-to-prevent-pre-eclampsia

  You should start taking low-dose aspirin between 12 to 16 weeks pregnant, ideally at 12 weeks. […] We recommend you continue taking low-dose aspirin until 36 weeks of pregnancy. […] Please note, we do not recommend taking high-dose aspirin (more than 150mg) during pregnancy. […] Although we recommend that you take aspirin for this reason, it is an unlicensed use of the medicine. This means it is not officially approved as a treatment to reduce the risk of pre-eclampsia.

• #16 Dietary supplements and prevention of preeclampsia | Hypertension Research

  https://www.nature.com/articles/s41440-025-02144-9

  Calcium plays an important role in the regulation of vascular smooth muscle and vascular endothelial function and contributes to normal blood pressure regulation. […] Since 2011, the World Health Organization (WHO) has recommended calcium supplementation to prevent PE in pregnant women with low calcium intake. […] A recent meta-analysis in 2022 showed that calcium supplementation significantly reduced the risk of developing PE (RR: 0.49, 0.390.61) (30 studies, n=20,445). […] To date, the evidence for calcium supplementation is of high quality; therefore, calcium supplementation is recommended during pregnancy in settings where calcium intake is low (e.g., 800mg/day). […] Therefore, calcium supplementation is expected to be effective in preventing PE in Japan, one of the countries with low calcium intake.

• #17 Preventing Pre-eclampsia and its Complications | Article | GLOWM

  https://www.glowm.com/article/heading/vol-2–health-and-risk-in-pregnancy-and-childbirth–preventing-preeclampsia-and-its-complications/id/416343

  There is considerable literature devoted to the prevention of pre-eclampsia in order to minimize the risk of the associated maternal and perinatal complications. The primary therapies of interest include lifestyle changes, aspirin, calcium, vitamin supplementation, and anticoagulant therapy with heparin. […] Current evidence supports two main interventions. Firstly, in women at increased risk, the use of low-dose aspirin (150 mg/day), ideally commenced prior to 16 weeks gestation is associated with a decreased incidence of preterm pre-eclampsia. Secondly, in populations with low dietary calcium intake, calcium supplementation (at least 1 g/day) may be of benefit. […] The treatment effect of aspirin appeared to be consistent across various subgroups according to maternal characteristics and medical history, with the exception of those with chronic hypertension.

• #18 Dietary supplements and prevention of preeclampsia | Hypertension Research

  https://www.nature.com/articles/s41440-025-02144-9

  Although the WHO currently recommends a calcium supplementation dose of 15002000mg/day, evidence reported by Dwarkanath et al. provides an opportunity to address this issue. […] Considering the above, low-dose supplementation (500mg) is reasonable from the standpoint of cost and effort of high-dose supplementation. […] Calcium supplementation of 10001500mg is generally safe. […] Therefore, low-dose calcium supplementation (500mg/day) is recommended during pregnancy in regions with low calcium intake, including in Japan.

• #19 Improving access to lifesaving tools for prevention, diagnosis, and management of pre-eclampsia and maternal anemia – Unitaid

  https://unitaid.org/call-for-proposal/improving-access-to-lifesaving-tools-for-prevention-diagnosis-and-management-of-pre-eclampsia-and-maternal-anemia/

  For PE, new evidence on calcium supplements has shown that a lower-dose (500mg) regimen is just as effective as the recommended higher-dose approach (1500mg). […] For anemia prevention, there is potential for multiple micronutrient supplements to replace IFA. […] To improve PE outcomes, it is critical to reduce delays in identifying and managing pregnant women at risk. […] The primary clinical indicators of PE are proteinuria (protein in urine) and high blood pressure (BP). […] Fortunately, there are new innovations with potential to make a difference, including semi-automated BP devices that incorporate clinical decision-support functions, or digital tools, such as those offering BP measurement by mobile phone. […] Antihypertensive drugs to manage blood pressure and magnesium sulphate to prevent eclamptic seizures in women with severe PE.

• #20 Prevention of Preeclampsia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8236336/

  While ACOG and USPSTF utilize risk factors based on history and clinical characteristics to identify women at risk for developing preeclampsia, more recent studies have investigated the use of first-trimester screening tests which include assessment of serum PlGF concentration, uterine artery doppler studies, and other maternal parameters to identify patients at highest risk for developing preeclampsia who would benefit from prophylactic aspirin use. […] Some experts have advocated for universal aspirin use during pregnancy, due to its low cost of approximately $5 throughout pregnancy, its well-studied maternal and neonatal safety profile, and the potential for it to reduce the burden of preeclampsia, improve maternal and fetal outcomes, and reduce healthcare cost. […] Statins are competitive inhibitors of the enzyme 5-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, which converts HMG-CoA to mevalonic acid. Recently, there is growing interest in the role of statins to prevent preeclampsia due to increasing number of studies demonstrating strong biological plausibility to reverse or ameliorate several pathophysiological pathways associated with preeclampsia.

• #21 Prevention of Preeclampsia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8236336/

  Studies into the use of statins for preeclampsia have evaluated it using a therapeutic approach for patients who develop preeclampsia, and a prophylactic approach for women at high-risk for developing the disease. […] Metformin, or dimethyl-biguanide hydrochloride, is a biguanide used mainly as an anti-diabetic agent. […] However, clinical data on the effectiveness of metformin as a prophylactic agent for preeclampsia prevention are varied. […] The use of proton pump inhibitors including esomeprazole is safe in pregnancy, and has not been found to be associated with fetal teratogenicity, miscarriage or preterm birth. […] Contemporary research into prophylactic and therapeutic interventions for preeclampsia are providing novel and promising modalities.

• #22 Preeclampsia Treatment & Management: Approach Considerations, Prehospital Treatment, Care in Preeclampsia Without Severe Features

  https://emedicine.medscape.com/article/1476919-treatment

  On the basis of limited evidence from a systematic review and meta-analysis, the addition of lowmolecular weight heparin or unfractionated heparin to low-dose aspirin has the potential to reduce the prevalence of preeclampsia and birth of small-for-gestational-age neonates in women with a history of preeclampsia. […] Research into the use of calcium and vitamin C and E supplementations in low-risk populations did not find a reduction in the incidence of preeclampsia. […] A study by Vadillo-Ortega et al suggests that in a high-risk population, supplementation during pregnancy with a special food (eg, bars) containing L-arginine and antioxidant vitamins may reduce the risk of preeclampsia. […] Results from the Norwegian Mother and Child Cohort Study suggest that supplementation of milk-based probiotics may reduce the risk of preeclampsia in primiparous women.

• #23 Preventing Pre-eclampsia and its Complications | Article | GLOWM

  https://www.glowm.com/article/heading/vol-2–health-and-risk-in-pregnancy-and-childbirth–preventing-preeclampsia-and-its-complications/id/416343

  The current recommendations support the use of calcium supplementation for the prevention of pre-eclampsia in those with low dietary calcium intake. […] The purported benefit of treatments such as heparin for prophylaxis of preterm pre-eclampsia is not yet based on credible evidence and their use for the sole purpose of preventing preterm pre-eclampsia is neither justified nor recommended. […] The following are recommended for prevention of pre-eclampsia: low-dose aspirin for women identified to be at high risk and calcium supplementation (of at least 1 g/day) for women with low calcium intake.

• #24 Supplements Used in Prevention of Preeclampsia and for Labor Preparation – Whole Health Library

  https://www.va.gov/WHOLEHEALTHLIBRARY/tools/supplements-used-in-prevention-of-preeclampsia-and-for-labor-preparation.asp?next=

  Hypovitaminosis D has been associated with an increased risk of preeclampsia. Vitamin D plays a role in the development of preeclampsia by affecting blood pressure through calcium homeostasis and/or modulating inflammation and immunity. Insufficiency has also been linked to other adverse maternal and fetal outcomes, including poor fetal and infant bone mineralization, hypocalcemia, and rickets in neonates. A number of prospective observational studies have shown a high prevalence of hypovitaminosis D during pregnancy across ethnic groups and nationalities. […] One systematic review showed that maternal consumption of folic acid supplementation in pregnancy reduces the risk of preeclampsia. Most pregnant women already take folic acid in their prenatal vitamin for the prevention of neural tube defects. The prevention of preeclampsia is another reason to stress the importance of a daily prenatal vitamin.

• #25

  https://www.jci.org/articles/view/91300

  Prevention of preeclampsia and the role of vitamin D […] As treatment and screening options are limited, therapies that prevent preeclampsia, delay the onset of the disorder, or decrease disease severity would be beneficial. One of the best-studied agents for the prevention of preeclampsia is low-dose aspirin. The US Preventive Services Task Force (USPSTF) and the American College of Obstetricians and Gynecologists (ACOG) currently recommend the use of low-dose aspirin for the prevention of preeclampsia in high-risk women. […] In this issue, Mirzakhani et al. report the results of a planned secondary outcome from the Vitamin D Antenatal Asthma Reduction Trial (VDAART). […] Despite this, women with sufficient serum 25-hydroxyvitamin D (25OHD) levels, defined as a serum level greater than or equal to 30 ng/ml, during both early (10-18 weeks) and late (32-38 weeks) pregnancy had a decreased risk of preeclampsia. […] Currently, ACOG does not recommend routine screening of vitamin D deficiency among all pregnant women, but does indicate that screening can be considered for women deemed high risk for vitamin D deficiency. For women with vitamin D deficiency, ACOG recommends supplementation with 1,000 to 2,000 IU per day but states that there is insufficient evidence at this time to recommend supplementation for the purpose of preventing preeclampsia. […] Effective interventions that decrease the incidence of preeclampsia can potentially decrease maternal and neonatal morbidity and mortality.

• #26 Preeclampsia Prevention

  https://mobile.fpnotebook.com/CV/OB/PrclmpsPrvntn.htm

  Calcium Supplementation […] Calcium 1-2 g orally daily […] Dietary Calcium 600 mg/day […] Efficacy: Benefits (based on weak evidence) […] Lowers Preeclampsia risk […] Lowers Blood Pressure […] Systolic lowered 5.4 mmHg […] Diastolic lowered 3.4 mmhg […] Consistent Exercise initiated in early pregnancy reduces the risk of developing Gestational Hypertension and Preeclampsia […] Start aerobic Exercise early in pregnancy, for 30 minutes each on 3-4 days per week […] Avoid routine Magnesium Supplementation […] Avoid routine Omega-3 Fatty Acid Supplementation […] Avoid antioxidant Vitamin Supplementation.

• #27 Can Women Reduce Their Risk For Preeclampsia? – Lompoc Valley Medical Center

  https://www.lompocvmc.com/blogs/2022/august/can-women-reduce-their-risk-for-preeclampsia-/

  If you can, try to lose as much excess weight as possible before pregnancy to avoid preeclampsia. […] Women aged 35 and older are at higher risk for developing preeclampsia. […] Exercise offers countless benefits for pregnancy and is one of the most effective ways you may be able to avoid preeclampsia. […] Quality sleep is essential during pregnancy. Not only can it reduce your risk for preeclampsia, but it can help you feel more energized, given how tiring pregnancy can be. […] Many recent studies show a link between caffeine and preeclampsia. […] High amounts of salt and sodium can raise your blood pressure and increase your preeclampsia risk. […] Certain foods are loaded with nutrients and antioxidants that can naturally regulate your blood pressure and clean your blood and body of toxins.

• #28 Can Women Reduce Their Risk For Preeclampsia? – Lompoc Valley Medical Center

  https://www.lompocvmc.com/blogs/2022/august/can-women-reduce-their-risk-for-preeclampsia-/

  A Mediterranean diet during pregnancy is linked to a reduced risk of preeclampsia, according to a study published in a 2022 issue of the Journal of the American Heart Association. […] Attend all your OB-GYN appointments during pregnancy. All these appointments are necessary to ensure you and your baby are in good health. They also screen you for conditions like gestational diabetes and preeclampsia.

• #29 Pre-eclampsia and Diet | MyNutriWeb Blog

  https://mynutriweb.com/pre-eclampsia-and-diet/

  From the latter part of the last century, a range of dietary components were suggested as having the potential to reduce pre-eclampsia risk. These dietary components include vitamin C and E, fish oils or omega-3 long-chain polyunsaturated fatty acids (LC-PUFA), magnesium, zinc supplementation and salt. However, recent evidence shows that these factors have no significant effect on reducing the risk. Factors that have been found to reduce the risk of pre-eclampsia include maternal weight, fibre, vitamin D, calcium, selenium, prebiotics, and probiotics, multivitamin/mineral supplementation and specific dietary patterns. […] A high-fibre diet is recommended for pregnant women and those at risk of pre-eclampsia, aiming for a fibre intake of 25-30 g/day to reduce the risk. […] Dietary patterns before and during pregnancy play an important role in the development of gestational hypertension and pre-eclampsia.

• #30 Pre-eclampsia and Diet | MyNutriWeb Blog

  https://mynutriweb.com/pre-eclampsia-and-diet/

  Probiotics may aid in reducing inflammation and have also been shown to have antihypertensive effects when consumed alongside dairy products (which act as prebiotics). […] Vitamin D may play a protective role against pre-eclampsia through modulating pro-inflammatory responses, promoting the formation of new blood vessels and decreasing blood pressure. […] Calcium supplementation in pregnancy reduces risk of pre-eclampsia. […] Selenium supplementation is effective in reducing pre-eclampsia risk in women of inadequate selenium status. […] Multivitamins/minerals, which generally contain folic acid and vitamin B12, may also reduce the risk of pre-eclampsia through the protective mechanisms of the individual nutrients, some of which may work in synergy.

• #31 5 Ways to Help Prevent Preeclampsia for a Safer Pregnancy

  https://draxe.com/health/preeclampsia/

  Preeclampsia – Dr. Axe Pregnancy is a mostly beautiful thing. After all, it quite literally provides the gift of life. […] Unfortunately, however, pregnancy can come with complications even fatal ones. One of those complications is preeclampsia (PE), which is the leading cause of maternal-fetus mortality in developed nations. (1) […] While theres no way to fully prevent this disorder from developing or cure it once its been diagnosed, there are several things you can do to lower your risk. Research shows that the following natural remedies and lifestyle changes give you the greatest chance of having a healthy pregnancy and delivery free from preeclampsia. […] Researchers and doctors both stress that its important to get yourself prepared for pregnancy by reaching a healthy body weight, eating a nutrient-dense diet and working on getting into good physical shape prior to conceiving. Staying within a healthy weight range meaning maintaining a body mass index (BMI) that is within the normal range of 1925, or below 30 can greatly lower your chance for pregnancy complications.

• #32 5 Ways to Help Prevent Preeclampsia for a Safer Pregnancy

  https://draxe.com/health/preeclampsia/

  The benefits of exercise during pregnancy include reduced inflammation, help reaching and maintaining a healthy weight, and even defense against the effects of stress. Exercising in a moderate, appropriate way is associated with a healthy pregnancy, lower rate of infertility and reduced pregnancy complications. […] Doctors recommend you focus on eating plenty of vitamins, minerals and high-antioxidant foods prior to pregnancy to get your body ready to support another life. Its also a good idea to consume less salt and eat plenty of potassium-rich foods to fight high blood pressure prior to becoming pregnant. […] To stay hydrated and balance levels of sodium in your diet, drink enough water daily (at least eight glasses of water a day) and limit caffeinated or alcoholic drinks. Make sure to get enough sleep (at least seven to eight hours a night, or even more when pregnant) and build relaxing breaks into your day to reduce stress and feelings of being overwhelmed.

• #33 Aspirin Treatment for Women at Risk for Preeclampsia – ACOG, SMFM and USPSTF Recommendations – The ObG Project

  https://www.obgproject.com/2016/12/12/consider-aspirin-treatment-women-risk-preeclampsia-acog-uspstf-recommendations/

  ACOG/SMFM have released guidance aligned with USPSTF regarding the use of low-dose aspirin during pregnancy to prevent preeclampsia. When indicated, low-dose aspirin should be started between 12 to 28 weeks and continued until delivery. Optimally, aspirin usage should begin <16 weeks. [...] Offer low-dose aspirin (81 mg/day) to women with ≥1 high risk factors [...] Offer low-dose aspirin (81 mg/day) to women with ≥2 moderate risk factors [...] Note: USPSTF does allow for consideration of aspirin prophylaxis if ≥1 moderate risk factor is present and states “Clinicians should use clinical judgment in assessing the risk for preeclampsia and discuss the benefits and harms of low-dose aspirin use with their patients.” [...] In these instances, universal implementation (eg, offering low-dose aspirin to all patients within such practices or institutions) may be medically reasonable.

• #34

  https://journals.lww.com/mfm/fulltext/2019/07000/screening_and_prevention_of_preeclampsia.6.aspx

  Preeclampsia (PE) is a multisystem disorder of pregnancy classically characterized by hypertension with significant proteinuria after 20 weeks gestation. […] Traditional method of screening as recommended by professional guidelines has limited predictive performance and therefore should be updated to reflect recent scientific evidence that the target of screening should be preterm PE, the best way to identify the high-risk group is the Bayes-based method that combines maternal risk factors and biomarkers, the threshold should be set at screen positive rate of 10%, aspirin should be started before 16 weeks gestation, and the daily dose should be higher than 100 mg. […] Evidence from the aforementioned studies indicates that there is an effective screening tool for the identification of women at risk of developing preterm PE. This allows early introduction of prophylactic treatment and therapeutic intervention. Several approaches have been proposed to prevent PE, including the administration of low-dose aspirin, heparin, antioxidants, calcium supplementation, proton pump inhibitor, or metformin. The only proven effective preventive strategy is the administration of low-dose aspirin to high-risk women for preterm PE at 16 weeks gestation.

• #35

  https://journals.lww.com/mfm/fulltext/2019/07000/screening_and_prevention_of_preeclampsia.6.aspx

  There is now substantial evidence from the ASPRE trial that the rate of preterm PE can be reduced by 60% by low-dose aspirin started at 11-14 weeks of gestation in high-risk women identified by the Bayes-based prediction model. […] The latest systematic review and meta-analysis, including 16 randomized controlled trials with a total of 18,907 participants, has demonstrated that the administration of aspirin is associated with a reduction in the rate of preterm PE (RR: 0.62; 95% CI: 0.450.87).

• #36 Aspirin Treatment for Women at Risk for Preeclampsia – ACOG, SMFM and USPSTF Recommendations – The ObG Project

  https://www.obgproject.com/2016/12/12/consider-aspirin-treatment-women-risk-preeclampsia-acog-uspstf-recommendations/

  The USPSTF recommends the use of low-dose aspirin (81 mg/d) as preventive medication for preeclampsia after 12 weeks of gestation in persons who are at high risk for preeclampsia as per categories above (B recommendation – offer or provide this service). […] Various studies have incorporated not only clinical risk factors but also biochemical markers and ultrasound to determine which women are at risk for early onset preeclampsia and may benefit from aspirin prevention […] ACOG/SMFM considers the supporting data for the use of such combined risk assessment algorithms to be limited and without more prospective clinical utility trials, states that biomarkers and ultrasonography cannot accurately predict preeclampsia and should remain investigational.

• #37

  https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=hw2834

  If you have risk factors for preeclampsia, it may help to: […] It’s important to go to all of your prenatal visits. This helps your healthcare provider or midwife find and treat problems early. This may help you avoid preeclampsia. […] If you have mild preeclampsia, you will have frequent office visits. Your doctor or midwife will check on your baby, monitor your blood pressure and weight, and do urine and blood tests. […] If preeclampsia is severe or getting worse, you may need to be treated in the hospital. Your doctor or midwife will closely monitor you and your baby. You may get medicines to lower your blood pressure and magnesium sulfate to prevent seizures. […] After having preeclampsia, you have a higher risk for high blood pressure, heart disease, stroke, and kidney disease. To protect your health, work with your healthcare provider or midwife to build heart-healthy habits and get the checkups you need.

• #38 Prevention of preeclampsia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5127661/

  Currently, ACOG does not recommend routine screening of vitamin D deficiency among all pregnant women, but does indicate that screening can be considered for women deemed high risk for vitamin D deficiency. For women with vitamin D deficiency, ACOG recommends supplementation with 1,000 to 2,000 IU per day but states that there is insufficient evidence at this time to recommend supplementation for the purpose of preventing preeclampsia. […] Effective interventions that decrease the incidence of preeclampsia can potentially decrease maternal and neonatal morbidity and mortality.

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