Pre-eclampsia-eclampsia 1996: Preventable? Have disputes on its treatment been resolved?

Current Opinion in Nephrology and Hypertension

Volumn 5, Issue 5, 1996, Pages 452-458

  Lindheimer, Marshall D ^a,b  

^a UNIVERSITY OF CHICAGO   (United States)

^b UNIVERSITY OF CHICAGO MEDICAL CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACETYLSALICYLIC ACID; ANTIHYPERTENSIVE AGENT; ATENOLOL; CALCIUM; CAPTOPRIL; HYDRALAZINE; LABETALOL; METHYLDOPA; METOPROLOL; NIFEDIPINE; PHENYTOIN; THIAZIDE DIURETIC AGENT;

ECLAMPSIA; FEMALE; HUMAN; PREECLAMPSIA; PRIORITY JOURNAL; REVIEW;

EID: 0029961942     PISSN: 10624821     EISSN: None     Source Type: Journal    
DOI: 10.1097/00041552-199609000-00013     Document Type: Review

References (46)

1. August P, Lindheimer MD: Pathophysiology of preeclampsia. In Hypertension: pathophysiology, diagnosis, and management, 2nd edn. Edited by Laragh JH, Brenner BM. New York: Raven Press; 1995:2407-2426. This chapter orients the reader to the epidemiology, clinical course and pathophysiology of pre-eclampsia, including a focused discussion on several of the hypotheses into its cause.
2. Johenning A, Lindheimer MD: Hypertension in pregnancy. Curr Opin Nephrol Hypertens 1993, 2:307-313.
3. Sabbatini S: Pathophysiology and therapeutic strategies for hypertension in pregnancy. Curr Opin Nephrol Hypertens 1993, 2:763-774.
4. Beaufils M: Is low-dose aspirin effective in preventing hypertension in pregnancy? Curr Opin Nephrol Hypertens 1994, 3:237-240.
5. Sibai BM, Justermann L, Velasco J: Current understanding of severe preeclampsia, pregnancy-associated hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, hemolysis elevated liver enzymes, and low platelet syndrome, and postpartum acute renal failure: different clinical syndromes or just different names? Curr Opin Nephrol Hypertens 1994, 3:346-345.
6. Sibai MM, Caritis SN, Thom E, Klebanoff M, McNellis D, Rocco L, Paul RH, Romero R, Witter F, Rosen M, Depp R and the National Institutes of Child Health and Human Development Network of Maternal-Fetal Medicine Units: Prevention of preeclampsia with low-dose aspirin in healthy nulliparous women. N Engl J Med 1993, 329:1213-1218.
7. CLASP (Collaborative Low-dose Aspirin Study in Pregnancy) Collaborative Group: CLASP: a randomized trial of low-dose aspirin for the prevention and treatment of pre-eclampsia among 9364 women. Lancet 1994, 343:619-629 [see also editorial comments].
8. Parrazzini F, Bortolus R, Chatenoud L, Restelli S, Benedetto C: Follow-up of children in the Italian Study of Aspirin in Pregnancy [Letter]. Lancet 1994, 343:1235.
9. DiSessa TG, Moretti ML, Khoury A, Pullium DA, Arheart KL, Sibai BM: Cardiac function in fetuses and new born exposed to low-dose aspirin during pregnancy. Am J Obstet Gynecol 1994, 171:892-900.
10. Hauth JC, Goldenberg RL, Parker CR Jr, Cutter GR, Clives SP: Low dose aspirin: lack of association with an increase in abruptio placenta or perinatal mortality. Obstet Gynecol 1995, 85:1055-1058.
11. Sibai BM, Caritis SN, Thom E, Shaw K, McNellis D: Low-dose aspirin in nulliparous women: safety of continuous epidural block and correlation between bleeding time and maternal-neonatal bleeding complications. National Institute of Child Health and Human Development Maternal-Fetal Medicine Network. Am J Obstet Gynecol 1995, 172:1553-1557.
12. CLASP Collaborative Group: Low dose aspirin in pregnancy and early childhood development: follow-up of Collaborative Low-dose Aspirin Study in Pregnancy. Br J Obstet Gynaecol 1996, 102:861-868.
13. Italian Study of Aspirin in Pregnancy: Low dose aspirin in the prevention and treatment of intrauterine growth retardation and pregnancy-induced hypertension. Lancet 1993, 341:396-400.
14. ECPPA (Estudo Collaborativo para Prevençao da Pre-eclampsia com Aspirina) Collaborative Group: ECPPA: randomized trial of low dose aspirin for the prevention of maternal and fetal complications in high risk pregnant women. Br J Obstet Gynaecol 1996, 103:39-47.
15. Griffiths J, Rotchell YE, Cruickshank JK, Phillips-Gay M, Stewart A, Farrell B, Ayers S, Duley L: The Barbados Low-dose Aspirin Study in Pregnancy (BLASP): a population-based trial in a developing country with excess preeclampsia and perinatal mortality [Abstract]. West Indian Med J 1996, 45(suppl 2):26-27.
16. Forrester TE, Jones D, McCaw-Binns A, Palmer-Levy M, Wilks R, Bernard GW, Fletcher H, Mullings A, Ashley D, Golding J et al.: Low-dose aspirin in pregnancy - are there any benefits? [Abstract]. West Indian Med J 1996, 45(suppl 2):26. In this trial 6275 primiparas attending community clinics in two Jamaica parishes were randomized, and 97% of them were monitored throughout pregnancy. Aspirin failed to decrease the prevalence of pre-eclampsia, perinatal deaths or preterm births. Of some concern was that the women ingesting aspirin developed significantly more antenatal intrapartum and post-partum 'bleeding disorders' than those receiving placebo.
17. 2 reduction versus pregnancy outcome in a low-dose aspirin trial. Am J Obstet Gynecol 1995, 173:578-584.
18. Hauth JC, Goldenberg RL, Parker CR Jr, Philips JB III, Copper RL, DuBard MB, Cutter GR: Low-dose aspirin therapy to prevent preeclampsia. Am J Obstet Gynecol 1993, 168:1083-1091.
19. Hauth J, Owen J, Thom E, Goldenberg R, Sibai B, McNellis D: Prevention of preeclampsia with low-dose aspirin in nullipara [Abstract]. J Soc Gynecol Invest 1996, 3:86A.
20. Carroli G, Duley L, Belizan JM, Villar J: Calcium supplementation during pregnancy: a systematic review of randomized controlled trials. Br J Obstet Gynaecol 1994, 101:753-758.
21. Bucher HC, Guyatt GH, Cook RJ, Hatala R, Cook DJ, Lang JD, Hunt D: Effect of calcium supplementation on pregnancy-induced hypertension and preeclampsia: a meta-analysis of randomized controlled trials. JAMA 1996, 275:1113-1117. This meta-analysis of 14 small trials essentially duplicated three earlier meta-analyses, including [20], and concluded that calcium supplementation was associated with a very significant reduction in the prevalence of pre-eclampsia (> 60%). There were, however, no decrements in the prevalence of major adverse outcomes. The editorial which accompanied this article (and was reprinted in the US Congressional Record) proclaimed that calcium supplementation to prevent pre-eclampsia was a major breakthrough which would save lives and thousands of millions of dollars in medical costs, a view headlined by the international media. An advertisement blitz by manufacturers of oral calcium preparations followed. It is suggested that judgement be withheld until the outcome of a recently concluded multicenter trial, the size of which (> 4500 women randomized) implies that the results will not be as dramatic. Essentially, the calcium supplementation story may duplicate that of the aspirin prophylaxis saga, in which enthusiasm after similar meta-analyses of small studies was followed by disappointing results in the larger trials.
22. Onwude JL, Lilford RJ, Hjartardottir H, Staines A, Tuffnell D: A randomized double blind placebo controlled trial of fish oil in high risk pregnancy. Br J Obstet Gynaecol 1995, 102:95-100.
23. Bulstra-Ramkers MTE, Huisjes HJ, Visser GHA: The effects of 3G eicosapentaenoic acid on recurrence of intrauterine growth retardation and pregnancy induced hypertension. Br J Obstet Gynaecol 1995, 102:123-126.
24. Morris NH, Eaton BM, Dekker G: Nitric oxide, the endothelium, pregnancy and preeclampsia. Br J Obstet Gynaecol 1996, 103:4-15. This is a succinct review focusing on abnormalities in nitric oxide synthesis in the genesis of pre-eclampsia, and suggests that L-arginine supplementation in the diet of pregnant women might be 'worthwhile'.
25. Standley CA, Standley PR, Boge L, Russell E, Cotton DB: Intracellular magnesium levels are reduced in preeclampsia [Abstract]. Am J Obstet Gynecol 1996, 174:447.
26. Pascoal IF, Lindheimer MD, Nalbantian-Brandt C, Moawad AH, Umans JG: Contraction and relaxation abnormalities in resistance arteries from preeclamptic women [Abstract]. J Soc Obstet Gynecol 1995, 2:157.
27. Brown MA, Buddle ML: The importance of nonproteinuric hypertension in pregnancy. Hypertens Pregnancy 1995, 14:57-65.
28. Seshardi L, Ventkataraman I: Outcome of proteinuric versus nonproteinuric hypertension in pregnancy. J Reprod Med (in press).
29. Kyle PM, Buckley D, Kissane J, de Swiet M, Redman CW: The angiotensin sensitivity test and low dose aspirin are ineffective methods to predict and prevent hypertensive disorders in nulliparous pregnancy. Am J Obstet Gynecol 1995, 173:865-872. This study attacks one of the obstetrics literature's 'sacred cows'. An increased sensitivity to the pressor effects of angiotensin II at approximately 28 weeks gestation has been considered to be a very reliable predictor of pre-eclampsia, the test even being used to determine high-risk patients for trials. This ancillary study in the CLASP trial [7] failed to confirm this claim.
30. Halligan A, Shennan A, Thurston H, de Swiet M, Daylor D: Ambulatory blood pressure monitoring in pregnancy: the current state of the art. Hypertens Pregnancy 1995, 14:1-16. This is a good review of developments relating to ambulatory blood pressure monitoring in pregnancy women. This same group is about to complete a survey of more than 1000 gravidas, studied during gestational weeks 18 and 24, to assess the value of such monitoring to predict pre-eclampsia.
31. Sibai BM, Mercer BM, Schiff E, Friedman SA: Aggressive versus expectant management of severe preeclampsia at 28-32 weeks' gestation: a randomized controlled trial. Am J Obstet Gynecol 1994, 171:818-822.
32. Schiff E, Friedman SA, Sibai BM: Conservative management of severe preeclampsia remote from term. Obstet Gynecol 1994, 84:626-630.
33. Visser W, van Pampus MG, Treffers PE, Wallenburg HCS: Perinatal results of hemodynamic and conservative temporizing treatment in severe pre-eclampsia. Eur J Obstet Gynecol Reprod Biol 1994, 53:175-181.
34. Chari R, Friedman SA, O'Brien JM, Sibai BM: Daily antenatal testing in women with severe preeclampsia. Am J Obstet Gynecol 1995, 173:1207-1210.
35. Visser W, Wallenburg HC: Temporizing management of severe preeclampsia with and without the HELLP syndrome. Br J Obstet Gynaecol 1995, 102:111-117.
36. Barron WM: Hypertension. In Medical disorders during pregnancy, 2nd edn. Edited by Barron WM, Lindheimer MD. St Louis: Mosby; 1995:1-36.
37. Chari RS, Freidman SA, Sibai BM: Antihypertensive therapy during pregnancy. Fetal Maternal Med Rev 1995, 7:61-65.
38. Sibai BH: Treatment of hypertension in pregnant women. N Engl J Med 1996, 335:257-265. This article and [37] contain in-depth reviews of randomized trials which evaluated a variety of antihypertensive drugs in pregnant women. Also, [39] discusses the controversy of whether mild hypertension requires treatment (an issue which will remain unresolved until adequate multicenter trials are performed).
39. National High Blood Pressure Education Program Working Group Report on high blood pressure in pregnancy. Am J Obstet Gynecol 1990, 163:1689-1712.
40. Schobel HP, Fischer T, Weihprecht H, Schmeider RE: Sympathetic vasoconstrictor activity is increased in pregnancy-induced hypertension: direct evidence from microneurographic studies [Abstract 749]. In Seventh European Meeting on Hypertension, Milan (Italy), 9th-12th June, 1995. Milan: European Society of Hypertension; 1995:171.
41. Moodley J, Moodley W: Prophylactic anticonvulsant therapy in the hypertensive crisis of pregnancy: the need for a large randomized trial. Hypertens Pregnancy 1994, 13:245-252.
42. Burrows RE, Burrows EA: The feasibility of a control population for randomized control trial of seizure prophylaxis in the hypertensive disorders of pregnancy. Am J Obstet Gynecol 1995, 173:929-935.
43. The Eclampsia Collaborative Group: Which anticonvulsant for women with eclampsia? Evidence from the collaborative eclampsia trial. Lancet 1995, 345:1455-1463 [see also editorial comment]. This is another landmark trial, co-ordinated through the Perinatal Trials Service at Oxford and the Centro Rosarino de Estudios Perinatalis in Argentina, which evaluated patients in three continents. The results should end decades of controversy on the efficacy of magnesium sulfate in the treatment of eclampsia using a simple treatment protocol which is applicable in underdeveloped nations (where the incidence of eclampsia is still quite high).
44. Lucas MJ, Leveno KJ, Cunningham FG: A comparison of magnesium sulfate with phenytoin for the prevention of eclampsia. N Engl J Med 1995, 333:201-205 [see also editorial comment]. This is an important trial demonstrating the superiority of magnesium sulfate to phenytoin as the drug of choice to prevent eclampsia. However, it does not establish (as some believe) the necessity for women with pre-eclampsia to receive prophylactic anticonvulsant therapy in labor.
45. Belfort MA, Moise KJ: Effect of magnesium sulfate on maternal brain blood flow in preeclampsia: a randomized controlled study. Am J Obstet Gynecol 1992, 167:661-666.
46. Naidu S, Payne AJ, Moodley J, Hoffman M, Gous E: Randomized trial assessing the effect of phenytoin and magnesium sulfate using transcranial Doppler ultrasound. Br J Obstet Gynaecol 1996, 103:111-116.