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Table 1 Summary of findings for medications to prevent preeclampsia

From: Medications for preventing hypertensive disorders in high-risk pregnant women: a systematic review and network meta-analysis

Patient or population: Pregnant women at any gestational age at high risk of developing hypertensive disorders in pregnancy

Settings: Hospital setting

Intervention: Antiplatelet agents, anticoagulants, antioxidants, calcium, nitric oxide, and their combinations

Comparator: Placebo or no treatment

Outcome: Preeclampsia

Total studies: 77 RCTs

Total participants: 93,234

Direct estimates

RR (95% CI)

Certainty of evidence

Indirect estimates

RR (95% CI)

Certainty of evidence

Network estimates

RR (95% CI)

[95% PrI]

Certainty of evidence

SUCRA

Comments

Antiplatelets + calcium (1 RCT; 334 participants)

0.16 (0.03 to 0.75)

Lowa,b

0.45 (0.05 to 4.06)

Moderateb

0.19 (0.04 to 0.86)

[0.04 to 1.01]

Lowa,b

89.9%

There was no evidence of inconsistency for global inconsistency test (P = 0.459) and Dias’s inconsistency tests of the node splitting

Anticoagulants + antiplatelets + calcium (2 RCTs; 156 participants)

Not estimable

0.24 (0.03 to 1.79)

Very lowc,d

0.24 (0.03 to 1.79)

[0.03 to 2.07]

Very lowc,d

78.3%

Anticoagulants + antiplatelets (1 RCT; 20 participants)

0.31 (0.07 to 1.27)

Very lowd,e

0.46 (0.26 to 0.80)

Lowd

0.43 (0.26 to 0.73)

[0.19 to 1.01]

Lowd

74.2%

Calcium + antioxidants (1 RCT; 660 participants)

0.39 (0.16 to 0.96)

Lowe

0.93 (0.18 to 4.82)

Moderateb

0.47 (0.20 to 1.06)

[0.16 to 1.35]

Moderateb

66.8%

Calcium (13 RCTs; 26,021 participants)

0.61 (0.46 to 0.80)

Moderatef

0.69 (0.20 to 2.36)

Moderateb

0.61 (0.47 to 0.80)

[0.30 to 1.24]

Moderatef

54.4%

Anticoagulants (2 RCTs; 399 participants)

0.70 (0.28 to 1.79)

Moderateb

0.23 (0.02 to 2.28)

Moderateb

0.60 (0.25 to 1.43)

[0.20 to 1.80]

Moderateb

51.7%

Antiplatelets (31 RCTs; 41,953 participants)

0.68 (0.57 to 0.82)

Lowa,f

0.79 (0.27 to 2.33)

Moderateb

0.69 (0.57 to 0.82)

[0.35 to 1.35]

moderatef

43.7%

Antiplatelets + nitric oxide (No direct comparison)

Not estimable

Not estimable

0.80 (0.31 to 2.05)

[0.25 to 2.55]

lowd

34.5%

 

Antioxidants (25 RCTs; 24,768 participants)

0.76 (0.63 to 0.92)

Moderatef

2.72 (0.27 to 27.33)

Moderateb

0.77 (0.63 to 0.93)

[0.39 to 1.52]

Moderatef

32.3%

 

Nitric oxide (1 RCT; 68 participants)

1.35 (0.61 to 3.01)

Very lowd,e

Not estimable

1.35 (0.49 to 3.77)

[0.39 to 4.65]

Very lowd,e

11.4%

 
  1. GRADE Working Group grades of evidence
  2. High quality: Further research is very unlikely to change our confidence in the estimate of effect
  3. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
  4. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
  5. Very low quality: We are very uncertain about the estimate
  6. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)
  7. CI Confidence interval, PrI Prediction interval, RR Relative risk
  8. aWe downgraded (1) level for serious limitations in study design due to most of the studies being at unclear risk of bias
  9. bWe downgraded (1) level for serious imprecision due to wide confidence interval
  10. cWe downgraded (1) level for serious intransitivity due to without closed loop of intervention
  11. dWe downgraded (2) level for very serious imprecision due to wide confidence interval and small number of events and sample size
  12. eWe downgraded (2) level for very serious limitations in study design due to most of the studies being at high risk of bias
  13. fWe downgraded (1) level for serious publication bias due to asymmetry funnel plot and P-value of Egger’s test < 0.05