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Latest & greatest articles for preeclampsia
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Reflux nephropathy and the risk of preeclampsia and of other adverse pregnancy-related outcomes: a systematic review and meta-analysis of case series and reports in the new millennium. Reflux nephropathy is a common urinary tract malformation, and a substantial cause of morbidity in women of childbearing age. While recent studies provide further new information on pregnancy-related outcomes, their results are heterogeneous and a systematic meta-analysis may help the interpretation. The aim (...) preeclampsia (PE), pregnancy-induced hypertension (PIH), preterm birth, and newborns small for gestational age, we employed as a control group the low-risk pregnancies from a multicenter database including 1418 live-born singletons. Case reports were analyzed narratively.The search retrieved 2507 papers, of which 7 case series and 4 case reports were retained. The series report on 434 women with 879 pregnancies; no study reported controls. Compared to the low-risk controls, the meta-analysis showed
Planned early delivery or expectant management for late preterm pre-eclampsia (PHOENIX): a randomised controlled trial. In women with late preterm pre-eclampsia, the optimal time to initiate delivery is unclear because limitation of maternal disease progression needs to be balanced against infant complications. The aim of this trial was to determine whether planned earlier initiation of delivery reduces maternal adverse outcomes without substantial worsening of neonatal or infant outcomes (...) , compared with expectant management (usual care) in women with late preterm pre-eclampsia.In this parallel-group, non-masked, multicentre, randomised controlled trial done in 46 maternity units across England and Wales, we compared planned delivery versus expectant management (usual care) with individual randomisation in women with late preterm pre-eclampsia from 34 to less than 37 weeks' gestation and a singleton or dichorionic diamniotic twin pregnancy. The co-primary maternal outcome was a composite
Long term follow up of biomarkers of podocyte damage and renal function in patients with and without preeclampsia. preeclampsia can be associated with future renal disease.To measure changes in renal function overtime in patients with preeclampsia.urine and serum samples from eleven patients with preeclampsia and eight patients with a normal pregnancy were obtained during pregnancy, postpartum, and 3 years after delivery. Urine podocalyxin, protein, and serum creatinine were measured.after 3 (...) years, there were no significant differences in urinary podocalyxin in patients with or without preeclampsia: 4.34 ng/mg [2.69, 8.99] vs. 7.66 ng/mg [2.35, 13], p = 0.77. The same applied to urinary protein excretion: 81.5 mg/g [60.6, 105.5] vs. 43.2 mg/g [20.9, 139.3] p = 0.23. Serum creatinine was 0.86 mg/dL [0.7, 0.9] vs. 0.8 mg/dL [0.68, 1] p = 0.74 in those with and without preeclampsia. In normal patients, urinary podocalyxin decreased from 54.4 ng/mg [34.2, 76.9] during pregnancy to 7.66 ng
Does low-dose aspirin initiated before 11 weeks' gestation reduce the rate of preeclampsia? Preconception or early administration of low-dose aspirin might improve endometrial growth, placental vascularization, and organogenesis. Most studies have evaluated the potential benefit of preconception or early administration of low-dose aspirin in women with a history of recurrent pregnancy loss, women who have undergone in vitro fertilization, or women with thrombophilia or antiphospholipid syndrome (...) . These women are at an increased risk of placenta-associated complications of pregnancy, including preeclampsia, preterm delivery, and fetal growth restriction.We performed a systematic review and meta-analysis to evaluate the effect of low-dose aspirin initiated at <11 weeks' gestation on the risk of preeclampsia, gestational hypertension, or any hypertensive disorder of pregnancy. Secondary outcomes included preterm delivery at <37 weeks' gestation and fetal growth restriction.We searched in MEDLINE via
Vitamin D supplementation and incident preeclampsia: A systematic review and meta-analysis of randomized clinical trials. Maternal vitamin D deficiency has been associated with an increased risk for preeclampsia. Despite this, the current evidence regarding the efficacy of vitamin D supplementation in preventing preeclampsia is controversial. To assess the impact of vitamin D supplementation on the risk of preeclampsia, we performed a systematic review of the literature and a meta-analysis (...) of the available randomized clinical trials (RCTs).The primary outcome was preeclampsia. Subgroup analyses were carried out considering the timing of the supplementation, type of intervention and the study design. Meta-regression analysis, including the amount of vitamin D and maternal age, were planned to explore heterogeneity (PROSPERO database registration number: CRD42019119207).Data were pooled from 27 RCTs comprising 59 arms, which included overall 4777 participants, of whom 2487 were in the vitamin D
The association between calcium supplement and preeclampsia and gestational hypertension: a systematic review and meta-analysis of randomized trials. The purpose of this study is to investigate whether calcium supplement with or without other drugs could reduce the risk of preeclampsia and gestational hypertension based on existed evidence, and to clarify whether there is discrepant effect among different population and using different dose.PubMed, Cochrane library, and EMBASE database were (...) searched. Two authors independently screened all records and extracted data. The meta-analysis was performed to calculate risk ratios and 95% CIs using random-effects models.27 studies, with 28 492 pregnant women were included. The results showed calcium supplement was associated with lower incidence of preeclampsia (RR 0.51, 95% CI: 0.40 to 0.64) and gestational hypertension (RR 0.70, 95% CI: 0.60 to 0.82). Sub-analyses revealed high-dose (1.2-2 g/day), moderate-dose (0.6-1.2 g/day), and low-dose
The reduction of melatonin levels is associated with the development of preeclampsia: a meta-analysis. The aim of this analysis was to demonstrate the association between melatonin levels and the development of preeclampsia.Standardized mean difference (SMD) with 95% confidence interval (CI) was calculated using a random effects model.The pooled SMD between case and control was 1.40 (95% CI: 0.26, 2.55; P = 0.02). And the pooled SMD between mild PE and severe PE was 5.25 (95% CI: 1.5, 9.01; P (...) = 0.006).The meta-analysis illustrated that melatonin concentration was significantly lower in women with preeclampsia, and correlated with the severity of the disease.
A systematic review and meta-analysis indicates long-term risk of chronic and end-stage kidney disease after preeclampsia. Preeclampsia is a pregnancy-related syndrome of variable severity, classically characterized by acute kidney involvement, with hypertension and/or proteinuria and reduced kidney function. Once considered a self-limited disease healed by delivery, it is now acknowledged that preeclampsia can affect cardiovascular and kidney health in the long term. The entity of risk has (...) not been established and consequently follow-up policies have not been defined. Here we undertook a systematic review to gain better insights into the need for post-preeclampsia follow-up. Articles published between January 2000 and March 2018 were selected, dealing with at least 20 preeclampsia patients, with follow-up of 4 years or more (MEDLINE, Embase, and Cochrane Library). No quality selection or language restriction was performed. Of the 10,510 titles and abstracts originally considered, 21
Pre-eclampsia: pathophysiology and clinical implications. Pre-eclampsia is a common disorder that particularly affects first pregnancies. The clinical presentation is highly variable but hypertension and proteinuria are usually seen. These systemic signs arise from soluble factors released from the placenta as a result of a response to stress of syncytiotrophoblast. There are two sub-types: early and late onset pre-eclampsia, with others almost certainly yet to be identified. Early onset pre (...) -eclampsia arises owing to defective placentation, whilst late onset pre-eclampsia may center around interactions between normal senescence of the placenta and a maternal genetic predisposition to cardiovascular and metabolic disease. The causes, placental and maternal, vary among individuals. Recent research has focused on placental-uterine interactions in early pregnancy. The aim now is to translate these findings into new ways to predict, prevent, and treat pre-eclampsia.Published by the BMJ
, Australia. Ray Joel G JG Departments of Medicine and Obstetrics and Gynaecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. eng Journal Article Meta-Analysis 2018 03 26 United States Am J Obstet Gynecol 0370476 0002-9378 0 Platelet Aggregation Inhibitors R16CO5Y76E Aspirin AIM IM Aspirin administration & dosage Dose-Response Relationship, Drug Female Humans Platelet Aggregation Inhibitors administration & dosage Pre-Eclampsia prevention & control Pregnancy 2018 02 01 2018 (...) Optimal aspirin dosing for preeclampsia prevention. 29588190 2019 07 01 2019 07 01 1097-6868 219 1 2018 07 American journal of obstetrics and gynecology Am. J. Obstet. Gynecol. Optimal aspirin dosing for preeclampsia prevention. 117-118 S0002-9378(18)30232-1 10.1016/j.ajog.2018.03.018 Seidler Anna Lene AL NHMRC Clinical Trials Centre, University of Sydney, NSW, Australia. Electronic address: firstname.lastname@example.org. Askie Lisa L NHMRC Clinical Trials Centre, University of Sydney, NSW
Evaluation of Preeclampsia Results after Use of Metformin in Gestation: Systematic Review and Meta-analysis. Does the use of metformin have an influence on the outcomes of preeclampsia (PE)? The descriptors pregnancy, metformin, treatment, and preeclampsia associated with the Boolean operators AND and OR were found in the MEDLINE, LILACS, Embase and Cochrane databases. A flowchart with exclusion criteria and inclusion strategy using the Preferred Reporting Items for Systematic Reviews and Meta
Serum CA-125 levels in preeclampsia: A systematic review and meta-analysis. Preeclampsia is a leading cause of perinatal morbidity, although an optimal screening model is still under investigation. The aim of the present meta-analysis is to accumulate current evidence and evaluate the diagnostic accuracy of CA-125 in preeclampsia.Medline, Scopus, CENTRAL, Clinicaltrials.gov and Google Scholar were systematically searched. All studies reporting serum CA-125 among preeclamptic and healthy (...) pregnant women were selected.Nine studies involving 977 women were included. Meta-analysis revealed significant differences among patients with preeclampsia and control pregnant women (MD 15.86 IU/mL, 95% CI, 9.03-22.69). Patients with severe preeclampsia had significantly higher levels of CA-125 compared to patients with mild preeclampsia (MD 13.21 IU/mL, 95% CI, 1.94-24.49). Meta-regression analysis revealed that gestational age <34 weeks could positively affect this association.The present meta
A meta-analysis of tumor necrosis factor-Î± and FAS/FASL polymorphisms with risk of pre-eclampsia. Previous observations investigated the association of tumor necrosis factor-α (TNF-α), FAS and FASL polymorphisms with the risk of pre-eclampsia (PE). Conflicting results, however, were obtained. In this study, we aimed to evaluate the association between TNF-α -308 A/G, -850 C/T, -238 A/G, FAS -670 A/G, and FASL -844 C/T and PE risk using a meta-analysis. Pubmed, EBSCO, Embase, China National
Insufficient iodine nutrition status and the risk of pre-eclampsia: a protocol for systematic review and meta-analysis. Pre-eclampsia is one of the leading causes of maternal and perinatal morbidity and mortality worldwide. Although subclinical hypothyroidism (SCH) in pregnancy is one of the established risk factors for pre-eclampsia, the link between iodine deficiency, the main cause of hypothyroidism and pre-eclampsia remains uncertain. About two billion people live in areas with iodine (...) -control studies that directly determined the iodine nutrition status of women with pre-eclampsia and appropriate normotensive controls. A similar search will be conducted for cohort studies in which the incidence of pre-eclampsia among pregnant women with adequate and inadequate iodine nutrition status was reported. Databases including MEDLINE, EMBASE, Google Scholar, SCOPUS and Africa Wide Information will be searched up to 31 December 2018. Screening of identified articles and data extraction
Potential biological therapies for severe preeclampsia: a systematic review and meta-analysis. Preeclampsia remains a significant danger to both mother and child and current prevention and treatment management strategies are limited. The objective of this systematic review was to investigate the current literature on evidence for the use of the regenerative capacity of mesenchymal stem cell (MSC) therapy, the anticoagulant activity of antithrombin (AT), or the free radical scavenging activity (...) of alpha-1-microglobulin (A1M) as potential novel treatments for severe preeclampsia and Hemolysis, Elevated Liver enzymes, Low Platelet count (HELLP).We conducted a systematic review of potential biological therapies for preeclampsia. We screened MEDLINE and Embase from inception through May 2017 for studies using AT, A1M or MSCs as potential treatments for preeclampsia and/or HELLP. A meta-analysis was performed to pool data from randomized control trials (RCTs) with homogenous outcomes using
Using proteomics to advance the search for potential biomarkers for preeclampsia: A systematic review and meta-analysis. Preeclampsia (PE) is a leading cause of maternal and perinatal morbidity and mortality worldwide. Although predictive multiparametric screening is being developed, it is not applicable to nulliparous women, and is not applied to low-risk women. As PE is considered a heterogenous disorder, it is unlikely that any single multiparametric screening protocol containing a small
Increased serum iron levels in pregnant women with preeclampsia: a meta-analysis of observational studies. Our study aimed to investigate whether the serum iron levels in patients with preeclampsia were higher than in healthy pregnant women and to evaluate potential heterogeneities. We searched Pubmed, Embase, Web of Science and Medline databases for studies before September 2016. The standardised mean difference (SMD) and 95% confidence interval (CI) were used to combine results across (...) the studies, in addition to the random-effect model. A total of 10 studies involving 363 patients with preeclampsia and 370 healthy controls were eligible through the inclusion criteria. In comparison with healthy pregnant women, the serum iron levels are higher in the patients with preeclampsia [summary SMD = 0.28, 95% CI = 0.11-0.44], and this association was also significant in the case-control studies. The serum iron levels were higher in the pregnant women with preeclampsia than in the healthy
Placental growth factor testing to assess women with suspected pre-eclampsia: a multicentre, pragmatic, stepped-wedge cluster-randomised controlled trial. Previous prospective cohort studies have shown that angiogenic factors have a high diagnostic accuracy in women with suspected pre-eclampsia, but we remain uncertain of the effectiveness of these tests in a real-world setting. We therefore aimed to determine whether knowledge of the circulating concentration of placental growth factor (PlGF (...) ), an angiogenic factor, integrated with a clinical management algorithm, decreased the time for clinicians to make a diagnosis in women with suspected pre-eclampsia, and whether this approach reduced subsequent maternal or perinatal adverse outcomes.We did a multicentre, pragmatic, stepped-wedge cluster-randomised controlled trial in 11 maternity units in the UK, which were each responsible for 3000-9000 deliveries per year. Women aged 18 years and older who presented with suspected pre-eclampsia between 20
Assisted reproductive technology and the risk of preeclampsia: an updated systematic review and meta-analysis. The objective of this systematic review and meta-analyses was to assess the risk of preeclampsia among women who conceived with assisted reproductive technology (ART).We searched the ISI Web of Knowledge, Medline/PubMed, Scopus, and Embase (from inception to May 2017) for English language articles using a list of key words. In addition, reference lists from identified studies (...) a significant increase in preeclampsia in women who conceived by ART compared with those who conceived spontaneously (RR = 1.71, 95% CI = 1.11-2.62, p = 0.015).The findings of this systematic review indicate that the use of ART treatment is associated with a 1.71-fold increase in preeclampsia.
Pre-eclampsia and risk of later kidney disease: nationwide cohort study. To investigate associations between pre-eclampsia and later risk of kidney disease.Nationwide register based cohort study.Denmark.All women with at least one pregnancy lasting at least 20 weeks between 1978 and 2015.Hazard ratios comparing rates of kidney disease between women with and without a history of pre-eclampsia, stratified by gestational age at delivery and estimated using Cox regression.The cohort consisted of 1 (...) 072 330 women followed for 19 994 470 person years (average 18.6 years/woman). Compared with women with no previous pre-eclampsia, those with a history of pre-eclampsia were more likely to develop chronic renal conditions: hazard ratio 3.93 (95% confidence interval 2.90 to 5.33, for early preterm pre-eclampsia (delivery <34 weeks); 2.81 (2.13 to 3.71) for late preterm pre-eclampsia (delivery 34-36 weeks); 2.27 (2.02 to 2.55) for term pre-eclampsia (delivery ≥37 weeks). In particular, strong