Issues in Global Maternal Health - Trends in the management of Pre-eclampsia; a Systematic Review of the Literature

Aims: Pre-eclampsia (systolic blood pressure of >140 mmHg and diastolic blood pressure >90 mmHg) is a fundamentally unique condition, occurring in the post-partum as well as the pre-natal period of pregnancy. It is a progressive and acute condition, characterised by high blood pressure and proteinuria which can have deleterious impact on both the health of mother and child. Few reviews to date have examined trends in the pharmacological management of pre-eclampsia from a global perspective. The aim of this study was to highlight the pharmacological management strategies that currently operate on a global level to reduce the prevalence of pre-eclampsia. Method: An electronic search was conducted using Cochrane, Cinahl Plus, Medline and Science Direct for randomized controlled trials investigating the treatment and management of pre-eclampsia in pregnancy in addition to searching reference lists using a predefined search strategy. The review included quasi-randomised trials, randomised controlled trials, cohort studies and programme evaluations. The primary outcome measures incorporated theeffectiveness of a range of pharmacologicalinterventions. Risk of bias and the quality of evidence of the qualitative studies selected for inclusion were assessed using the Effective Public Health Practice Project Tool. Quantitative studies were assessed using SIGN Critical Appraisal Checklist 2 for randomized controlled trials. Results: The review identified 4,838articles of which 8 met the inclusion criteria. Eight papers were included in this review. From these eight papers, several interventions were used in the treatment and management of pre-eclampsia. Two of the eight studies (25%) investigated the efficacy of vitamins (Vitamins C and E) in the management of pre-eclampsia in pregnancy. One (12.5%) of the included study examined the effects of exercise in managing the condition while five (62.5%) investigated the efficacy of drugs/medicines. Conclusions: Pharmacologic interventions in pre-eclampsia with anti-hypertensive medications appear to be the most efficacious pharmacological intervention used in efforts to reduce the prevalence of the condition.