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CHERG - Child Epidemiology Reference Group

Preeclampsia and Eclampsia Management on Stillbirths

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More Intervention Effect Estimate Summaries

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.

Intervention Effects

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:

  1. 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.  
  2. 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.

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