Jabeen M, Yakoob MY, Imdad A, Bhutta ZA. Impact of interventions to prevent and manage preeclampsia and eclampsia on stillbirths. BMC Public Health 2011 11 (Suppl 3):S6.
- Hypertensive disease of pregnancy (HDP) occurs in 5-8% of pregnancies, and leads to adverse perinatal outcomes like low birth weight, prematurity, stillbirth and intrauterine growth retardation. (1, 2)
- Potential interventions for reducing the risk of developing preeclampsia during pregnancy include aspirin and calcium supplementation. Similarly magnesium sulphate and anti-hypertensive drugs are among interventions for managing preeclampsia and eclampsia.
Calcium Supplementation on Stillbirths
- Calcium supplementation ranging from 1.5-2 g/day reduced stillbirths by 19% (95% ci: 0.63-1.03) in a population at risk of low calcium intake
- Moderate quality of evidence – based on 3 randomized controlled trials
- Further research is needed with assessment of the full range of pregnancy outcomes
Aspirin on Stillbirths
- No significant effect on risk of stillbirths (RR = 1.15; 95% CI: 0.88-1.49) among high-risk pregnancies
- Low quality of evidence (21 RCTs) - No intervention recommendation
Anti-hypertensive Drugs on Stillbirths
- No significant effect on risk of stillbirths (RR = 1.14; 95% CI: 0.60-2.17) in pregnant women with mild to moderate hypertension
- Moderate/Low quality of evidence (18 RCTs) - No intervention recommendation
Magnesium Sulphate on Stillbirths
- No significant effect on risk of stillbirths (RR = 0.99; 95% CI: 0.87-1.12) for pregnancies with preeclampsia
- High/Moderate quality of evidence - No intervention recommendation
HDP Package on Stillbirths
- Package includes use of an appropriate antihypertensive, magnesium supplementation (in case of preeclampsia/eclampsia) and availability of C-section when required.
- Delphi consensus of 33 experts suggested a median effect of 20% reduction each in antepartum and intrapartum stillbirths (interquartile ranges of 10-30% and 10-40%, respectively). This was recommended for inclusion in the LiST model.
References from Jabeen Paper Cited Here:
- Yu CKH, P AT, parra M, Palma Das R, Nicolaides KH: Randomized controlled trial using low-dose aspirin in the prevention of pre-eclampsia in women with abnormal uterine Doppler at 23 weeks gestation. Ultrasound in Obstetrics & Gynecology 2003, 22:233-239.
- Italian Study of Aspirin in Pregnancy: Low-dose aspirin in prevention and treatment of intrauterine growth retardation and pregnancy-induced hypertension. Lancet 1993, 341(8842):396-400.