Abstract
Background: Preeclampsia is a hypertensive disorder of pregnancy with a high rate of neonatal and maternal morbidity and mortality. The only definitive treatment is delivery. Through pre-clinical studies, proton pump inhibitors (PPIs), which are commonly and safely used in pregnancy, have been identified as potential therapeutic agents. Objective: To undertake a systematic review evaluating PPIs in the prevention and/or treatment of preeclampsia and gestational hypertension. Search strategy: Electronic databases were searched from inception to 2018. Search terms included preeclampsia, proton-pump inhibitors, pregnancy-induced hypertension, lansoprazole, rabeprazole, esomeprazole and omeprazole. Selection criteria: Studies were included if they were randomized control trials, case-control or cohort studies on human subjects. Case reports, review articles, opinion pieces and conference abstracts were excluded as well as studies with no or inappropriate control arms. Data collection and analysis: Only one eligible study was identified, so no analyses were able to be performed. Main results: There was only one clinical trial eligible for inclusion. This was a randomized clinical trial investigating the role of PPIs in the treatment of preterm preeclampsia in a high-risk, inpatient setting. This was a negative finding, with no change in the primary outcome of prolongation of gestation between the PPI group and placebo control. Conclusion: There is a scarcity of clinical trials published investigating the therapeutic potential of PPIs for preeclampsia and gestational hypertension. Of the one available study, PPIs were not found to prolong gestation among preterm preeclamptic patients compared to placebo control. In order to further elucidate the clinical potential of PPIs to prevent or treat preeclampsia, further trials are required.
Highlights
Preeclampsia is a hypertensive disorder of pregnancy, affecting 3% - 8% of pregnant women, globally [1] [2]
In laboratory studies we demonstrated that pump inhibitors (PPIs) significantly reduced the secretion of two anti-angiogenic factors that may be driving the pathogenesis of preeclampsia, soluble Fms-like tyrosine kinase-1 (sFLT-1) and soluble endoglin (sEng)
The remaining study that was eligible for inclusion in the analysis investigated PPIs in a randomized placebo-controlled trial among women with preterm preeclampsia
Summary
Preeclampsia is a hypertensive disorder of pregnancy, affecting 3% - 8% of pregnant women, globally [1] [2]. There are no medical therapeutics available for preeclampsia and delivery is the only definite treatment, which at preterm gestations can result in significant neonatal morbidity and mortality [5] [6]. Through pre-clinical studies, proton pump inhibitors (PPIs), which are commonly and safely used in pregnancy, have been identified as potential therapeutic agents. Main results: There was only one clinical trial eligible for inclusion This was a randomized clinical trial investigating the role of PPIs in the treatment of preterm preeclampsia in a high-risk, inpatient setting. This was a negative finding, with no change in the primary outcome of prolongation of gestation between the PPI group and placebo control. Of the one available study, PPIs were not found to pro-
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