Can pre-eclampsia be prevented?

Abstract

Pre-eclampsia is a multisystemic disease, unique to humans, affecting 2-4% of all pregnancies. In Argentina, it was the leading cause of maternal death in 2022. The most effective strategies for preventing pre-eclampsia include aspirin administration, calcium supplementation if daily intake is less than 900 mg/day, and physical activity¹. The importance of prevention lies not only in avoiding maternal and foetal morbidity and mortality but also the long-term risks of hypertension, cardiovascular disease and death, among others, which are proven to be increased in patients who have had pre-eclampsia^1,2.

 According to the ASPRE study, administration to patients at high risk of pre-eclampsia of 150 mg acetylsalicylic acid before 16 weeks, at night and regularly until 36 weeks gestational age decreased pre-eclampsia before 37 weeks by 62% (1.6 vs. 4.3%) and pre-eclampsia before 34 weeks by 82% (0.4 vs. 1.8%)(3)(4). Administration of calcium to patients at risk of pre-eclampsia with calcium intake below 900mg/day reduces the incidence of pre-eclampsia by 50%. The suggested dose is at least 500 mg/day as similar results have been seen with high and low dose schedules. Administration can be initiated at any time during pregnancy as there is no risk of teratogenesis². Moderate exercise of 140 minutes or more per week reduces the risk of pre-eclampsia by 40%¹. Although not yet incorporated into standard therapy, studies have shown that the use of pravastativa (20 mg) given to 35-36 week pregnancies at high risk of late pre-eclampsia would reduce the incidence of late pre-eclampsia¹.

Given that the strategies are efficient, the challenge is the detection of the patient at high risk of pre-eclampsia. Although multivariate models involving maternal risk factors and biomarkers, such as that of the Fetal Medicine Foundation, detect approximately 90% of high-risk patients in the first trimester, they are difficult to implement in many regions of our country. Given the impact of pre-eclampsia on maternal and foetal morbidity and mortality, new risk markers continue to be analysed, such as the maternal ophthalmic artery Doppler, which will soon be incorporated into screening^3,4.