Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Department of Health Policy, National Center for Child Health and Development, Setagaya-ku, Japan.
Syst Rev. 2022 Jul 1;11(1):135. doi: 10.1186/s13643-022-01978-5.
To determine the relative effectiveness of medications for preventing hypertensive disorders in high-risk pregnant women and to provide a ranking of medications using network meta-analysis.
All randomized controlled trials comparing the most commonly used medications to prevent hypertensive disorders in high-risk pregnant women that are nulliparity and pregnant women having family history of preeclampsia, history of pregnancy-induced hypertension in previous pregnancy, obstetric risks, or underlying medical diseases. We received the search results from the Cochrane Pregnancy and Childbirth's Specialised Register of Controlled Trials, searched on 31st July 2020. At least two review authors independently selected the included studies and extracted the data and the methodological quality. The comparative risk ratios (RR) and 95% confidence intervals (CI) were analyzed using pairwise and network meta-analyses, and treatment rankings were estimated by the surface under the cumulative ranking curve for preventing preeclampsia (PE), gestational hypertension (GHT), and superimposed preeclampsia (SPE). Safety of the medications is also important for decision-making along with effectiveness which will be reported in a separate review.
This network meta-analysis included 83 randomized studies, involving 93,864 women across global regions. Three medications, either alone or in combination, probably prevented PE in high-risk pregnant women when compared with a placebo or no treatment from network analysis: antiplatelet agents with calcium (RR 0.19, 95% CI 0.04 to 0.86; 1 study; low-quality evidence), calcium (RR 0.61, 95% CI 0.47 to 0.80; 13 studies; moderate-quality evidence), antiplatelet agents (RR 0.69, 95% CI 0.57 to 0.82; 31 studies; moderate-quality evidence), and antioxidants (RR 0.77, 95% CI 0.63 to 0.93; 25 studies; moderate-quality evidence). Calcium probably prevented PE (RR 0.63, 95% CI 0.46 to 0.86; 11 studies; moderate-quality evidence) and GHT (RR 0.89, 95% CI 0.84 to 0.95; 8 studies; high-quality evidence) in nulliparous/primigravida women. Few included studies for the outcome of superimposed preeclampsia were found.
Antiplatelet agents, calcium, and their combinations were most effective medications for preventing hypertensive disorders in high-risk pregnant women when compared with a placebo or no treatment. Any high-risk characteristics for women are important in deciding the best medications. The qualities of evidence were mostly rated to be moderate.
PROSPERO CRD42018096276.
确定预防高危孕妇高血压疾病的药物的相对有效性，并使用网络荟萃分析对药物进行排名。
所有比较最常用于预防高危孕妇高血压疾病的药物的随机对照试验，这些孕妇为初产妇和有先兆子痫家族史、既往妊娠有妊娠高血压史、产科风险或潜在疾病的孕妇。我们从 Cochrane 妊娠和分娩特有的对照试验注册库中检索到搜索结果，检索日期为 2020 年 7 月 31 日。至少两名综述作者独立选择纳入的研究并提取数据和方法学质量。使用两两和网络荟萃分析分析比较风险比（RR）和 95%置信区间（CI），并通过预防子痫前期（PE）、妊娠期高血压（GHT）和重叠性子痫前期（SPE）的累积排序曲线下面积估计治疗排名。药物的安全性与有效性一样重要，将在另一项单独的综述中报告。
本网络荟萃分析纳入了来自全球各地的 83 项随机研究，涉及 93864 名女性。三种药物（单独或联合使用）可能与安慰剂或不治疗相比，预防高危孕妇的 PE：抗血小板药物与钙（RR 0.19，95%CI 0.04 至 0.86；1 项研究；低质量证据）、钙（RR 0.61，95%CI 0.47 至 0.80；13 项研究；中等质量证据）、抗血小板药物（RR 0.69，95%CI 0.57 至 0.82；31 项研究；中等质量证据）和抗氧化剂（RR 0.77，95%CI 0.63 至 0.93；25 项研究；中等质量证据）。钙可能预防初产妇/经产妇的 PE（RR 0.63，95%CI 0.46 至 0.86；11 项研究；中等质量证据）和 GHT（RR 0.89，95%CI 0.84 至 0.95；8 项研究；高质量证据）。对于重叠性子痫前期的结局，纳入的研究很少。
与安慰剂或不治疗相比，抗血小板药物、钙及其联合使用是预防高危孕妇高血压疾病最有效的药物。女性的任何高危特征对决定最佳药物都很重要。证据质量大多被评为中等。
PROSPERO CRD42018096276。
Zotero 插件
