982 Postpartum diuretic therapy in women with preeclampsia: a meta-analysis

Abstract

Our objective was to conduct a systematic review and meta-analysis using available data from RCTs that evaluated the use of diuretic therapy in the postpartum management of preeclampsia. A systematic literature review was conducted using PubMed, Cochrane, and Embase using relevant search terms. Secondary citations from retrieved papers were also reviewed. We performed a meta-analysis of randomized trials of deliveries complicated by preeclampsia who were treated with a diuretic or placebo/no treatment in the immediate postpartum period. Clinical characteristics, outcome measures, treatment subtypes were extracted. Outcome data were abstracted and meta-analysis was conducted using the Mantel-Haenszel fixed effects model with test of heterogeneity. Five RCTs met inclusion criteria, with 590 women (Treatment n=296, Control n=294). The treatment group needed significantly less inpatient anti-hypertensive medication or dose escalation p<0.015 (3 studies, n=482, odds ratio (OR) 0.61, 95% confidence interval (CI) 0.42 to 0.91). Use of diuretic therapy was also associated with fewer women requiring anti-hypertensive medication at discharge (5 studies, n=590, OR 0.67, 95% CI 0.47 to 0.94, p=0.02). Among the subset of women with preeclampsia with severe features, diuretic therapy was associated with significantly less additional anti-hypertensive medication use (2 studies, n=170, OR 0.24, 95% CI 0.11 to 0.52, p=0.0003), and these patients were less likely to require an anti-hypertensive medication at discharge (3 studies, n=260, OR 0.38, 95% CI 0.21 to 0.67, p=0.001). No statistically significant differences were noted in readmissions for hypertensive control, length of hospital stay, or adverse events. Postpartum administration of a loop diuretic following delivery complicated by preeclampsia decreases the need for additional postpartum anti-hypertensive therapy or dose escalation and decreases the need for anti-hypertensive therapy at time of discharge. Additional research is needed to elucidate optimal treatment regimens to maximize efficacy and minimize risk.