The following is a summary of “Comparative effectiveness of prophylactic strategies for preeclampsia: a network meta-analysis of randomized controlled trials,” published in the MAY 2023 issue of Obstetrics and Gynecology by Liu, et al.

For a study, researchers sought to compare the efficacy of various prophylactic strategies for preventing preeclampsia in at-risk pregnant women. They aimed to assess the evidence from head-to-head clinical trials and provide insights into the effectiveness of different interventions.

A comprehensive search was conducted in PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov, and the references of key articles and previous meta-analyses. Articles published up to September 2021 were included. Randomized controlled trials comparing prophylactic strategies for preeclampsia prevention, either against each other or negative controls, were eligible for inclusion in the study.

Two reviewers independently collected data, evaluated the risk of bias, and assessed the certainty of evidence. The efficacy of prophylactic strategies was estimated using frequentist and Bayesian network meta-analysis models. The primary composite outcome was preeclampsia/pregnancy-induced hypertension.

A total of 130 trials involving 112,916 patients were included to evaluate 13 prophylactic strategies. Low-molecular-weight heparin (0.60; 95% CI, 0.42–0.87), vitamin D supplementation (0.65; 95% CI, 0.45–0.95), and exercise (0.68; 95% CI, 0.50–0.92) were as efficacious as calcium supplementation (0.71; 95% CI, 0.62-0.82) and aspirin (0.79; 95% CI, 0.72-0.86) in preventing preeclampsia/pregnancy-induced hypertension. 

As measured by the P score ranking, their efficacy was 85%, 79%, 76%, 74%, and 61%, respectively. In head-to-head comparisons, no significant differences were observed between these effective strategies, except that exercise tended to be superior to aspirin and calcium supplementation in preventing pregnancy-induced hypertension. The prophylactic effects of aspirin and calcium supplementation were consistent across subgroups. However, the results of low-molecular-weight heparin, exercise, and vitamin D supplementation varied depending on risk populations, dosages, and geographic areas. The certainty of evidence ranged from moderate to very low.

Low-molecular-weight heparin, vitamin D supplementation, exercise, calcium supplementation, and aspirin were all found to reduce the risk of preeclampsia/pregnancy-induced hypertension. No significant differences were observed between these effective prophylactic strategies in preventing preeclampsia. However, the study highlighted the need to evaluate further the prophylactic effects of low-molecular-weight heparin, vitamin D supplementation, and exercise for preeclampsia prevention.

Source: ajog.org/article/S0002-9378(22)00819-5/fulltext