Preventionofpreeclampsia.pptVIP

Prevention of preeclampsia Jim Roberts Introduction The NICHD/NHLBI will soon begin a very large (9 to 12,000 women) and very expensive study of antioxidant therapy to attempt to prevent the pregnancy complication, preeclampsia. What background data and principles should guide such a study? Goals What is preeclampsia? Prior attempts to prevent preeclampsia What can we learn? Principles to guide preventive therapy Rationale for antioxidant therapy Skeleton of study design (work in progress) Preeclampsia Clinical (pregnancy specific syndrome) Hypertension Proteinuria Impact Leading cause of maternal mortality 5 fold increase in perinatal mortality 15% of preterm births Treatment of PreeclampsiaDelivery! Usually prevents maternal mortality. Does not prevent maternal morbidity. Can result in iatrogenic prematurity. Treatment of Preeclampsia The best treatment is prevention! Preeclampsia ProphylaxisHistory Salt restriction Salt supplementation Protein restriction Protein supplementation Eat less Eat more Rest less Rest more etc., etc., etc. ... Principles of Prophylaxis Successful preventive therapy requires: Sufficient understanding of the disease to direct strategy The ability to identify patients at enough risk to justify prophylaxis “Prophylactic” treatment may actually be early therapy. Preventive therapy must prevent the disease and not merely the diagnosis of the disease. “Decreasing the Diagnosis” Preeclampsia is diagnosed by: ? increased blood pressure ? proteinuria These are not important pathophysiological features! Drugs which lower BP or prevents proteinuria will reduce the dx. Have not prevented the disorder only the diagnosis. Calcium SupplementationRationale Hypocalcuria in preeclampsia ? antedates disease Increased intracytoplasmic calcium platelets: basal yes/no stimulated yes/no Epidemiology low calcium diets = more preeclampsia (South and Central America and Africa) Calcium SupplementationClinical trials and meta-analysis