PREVENTION OF PREECLAMPSIA: CURRENT STATE OF THE PROBLEM
DOI:
https://doi.org/10.11603/24116-4944.2023.1.13941Keywords:
preeclampsia, pregnancy, prevention, hypertensionAbstract
Preeclampsia – a classic pregnancy-associated disease, which has a negative impact on both the pregnant woman and the fetus. It is important to prevent the disease to improve perinatal outcomes. Usually, women at risk are prescribed acetylsalicylic acid, and those who do not get enough calcium in their diet are given calcium preparations. However, due to their insufficient effectiveness, the search for new alternative methods is actively continued. Among them, the use of low-molecular-weight heparins, metformin, pravastatin, vitamins D, C and E, folic acid, magnesium, omega-3 polyunsaturated fatty acids, physical activity or, on the contrary, physical rest, deserve the most attention. Low-molecular-weight heparin has a beneficial effect on blood vessels, and it is likely that it may benefit women at the highest risk of early preeclampsia. Clinical studies have shown that metformin can reduce the risk of gestational hypertension in women with gestational diabetes and can prevent preeclampsia. Pravastatin reduces the secretion of endothelin-1 and soluble fms-like tyrosine kinase-1 in human umbilical vein endothelial cells and uterine microvascular cells. Vitamin D can be a powerful endocrine suppressor and regulate the renin-angiotensin system, which plays an important role in regulating blood pressure. Since one of the potential mechanisms of preeclampsia development is oxidative stress, the addition of antioxidants may reduce the severity of the disease or prevent its occurrence. Antioxidant vitamins contribute to the stabilization of reactive free radicals, which act as the first line of defense against free radicals and lipid peroxidation. An increased level of homocysteine in the blood is the cause of gestational hypertension and preeclampsia, folic acid can reduce its level. Taking oral magnesium supplements may reduce the risk of preeclampsia, but the effect is likely to be more pronounced in high-risk pregnant women. In a meta-analysis, omega-3 supplementation was shown to reduce the risk of preeclampsia by 16 %. Exercise can reduce the risk of gestational hypertension and preeclampsia by ≈30 % and 40 %, respectively. Rest is thought to be beneficial for women at increased risk of preeclampsia, including those with normal blood pressure. All alternative preventive methods with a differentiated approach can find a place in the preeclampsia prevention strategy.
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