Preeclampsia Prevention

Aka: Preeclampsia Prevention, Preeclampsia Prophylaxis, PIH Prophylaxis, HELLP Prevention, Pregnancy Induced Hypertension Prophylaxis

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II. Indications: Preeclampsia risk factors

  1. High risks
    1. Autoimmune Disease (Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome)
    2. Preeclampsia in prior pregnancy
    3. Chronic Hypertension
    4. Diabetes Mellitus
    5. Chronic Kidney Disease
    6. Multiple Gestation
  2. Moderate risks
    1. Advanced maternal age (35 years old or older)
    2. Family History of Preeclampsia in a first degree relative (mother, sister)
    3. Black race
    4. Obesity (BMI >30 kg/m2)
    5. Nulliparity or more than 10 years between pregnancies
    6. History of Low Birth Weight Infant or adverse pregnancy outcome
    7. Low socioeconomic status

III. Management: Aspirin 81 mg/day

  1. ACOG and USPTF Indications (to start in first trimester)
    1. One Preeclampsia high risk factor or two moderate risk factors (sere above)
    2. This replaces the older, more limited criteria focused on prior Preeclampsia in pregnancy
    3. (2018) Obstet Gynecol 132(1):e44-e52 +PMID:29939940 [PubMed]
  2. Protocol
    1. Aspirin 81 mg orally daily
    2. Start at 12 to 28 weeks (preferably by 16 weeks gestation)
    3. Continue Aspirin until delivery
  3. Efficacy: Benefits
    1. Prevents Pregnancy Induced Hypertension
    2. Prevents Intrauterine Growth Retardation
  4. Efficacy: Number Needed to Treat (NNT) to prevent one case of Preeclampsia
    1. NNT: 69 (overall)
    2. NNT: 18 (if highest risk factors present)
  5. References
    1. Coomarasamy (2003) Obstet Gynecol 101:1319-32 [PubMed]

IV. Management: Calcium Supplementation

  1. Dose
    1. Calcium 1-2 g orally daily
  2. Indications
    1. Dietary Calcium <600 mg/day
  3. Efficacy: Benefits (based on weak evidence)
    1. Lowers Preeclampsia risk
    2. Lowers Blood Pressure
      1. Systolic lowered 5.4 mmHg
      2. Diastolic lowered 3.4 mmhg
  4. Reference
    1. Bucher HC (1996) JAMA 275:1113-7 [PubMed]

V. Management: Other Measures

  1. Consistent Exercise initiated in early pregnancy reduces the risk of developing Gestational Hypertension and Preeclampsia
    1. Start aerobic Exercise early in pregnancy, for 30 minutes each on 3-4 days per week
    2. Davenport (2018) Br J Sports Med 52(21): 1367-75 [PubMed]

VI. 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

VII. References

  1. (2019) Am Fam Physician 100(10): 649-50
  2. Farahi (2024) Am Fam Physician 109(3): 251-60 [PubMed]
  3. Fontaine (2000) in ALSO, B:1-36
  4. Sibai in Gabbe (2002) Obstetrics, p. 945-74
  5. (2000) Am J Obstet Gynecol 183(1):S1-22 [PubMed]
  6. Zamorski (2001) Clin Fam Pract 3:329-47 [PubMed]

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