Maternal‐neonatal events resulting from medications for preventing hypertensive disorders in high‐risk pregnant women: A systematic review and network meta‐analysis

Background There have been few studies reporting on maternal and neonatal events in high‐risk pregnant women receiving medications for preventing hypertensive disorders of pregnancy (HDP). Objective To identify placental abruption, postpartum hemorrhage, neonatal intraventricular hemorrhage, and neonates with small for gestational age (SGA) or growth restriction resulting from medications for preventing HDP in high‐risk pregnant women using a network meta‐analysis. Search strategy All randomized controlled trials comparing the most commonly used medications (antiplatelet agents, anticoagulants, antioxidants, nitric oxide, and calcium) for preventing HDP in high‐risk pregnant women were searched from the Cochrane Pregnancy and Childbirth's Specialized Register of Controlled Trials until July 31, 2020, without language restriction. Selection criteria Two of the authors independently selected the eligible trials. Data collection and analysis Two authors independently extracted the data and assessed the methodological quality of the included trials. Pairwise and network meta‐analyses were used to determine comparative risk ratios and 95% confidence intervals. Main results The 51 included trials involved 69 669 pregnant women. Compared with placebo/no treatment, antioxidants slightly reduced placental abruption with high‐certainty evidence. Antiplatelet agents probably reduced SGA with low‐certainty evidence and slightly increased neonatal intraventricular hemorrhage with moderate‐certainty evidence. Conclusion Antiplatelet agents probably reduce SGA, but neonatal intraventricular hemorrhage should be monitored. Systematic review registration PROSPERO, CRD42018096276. Synopsis Antiplatelet agents administered for preventing hypertengefosive disorders of pregnancy probably reduce small for gestational age in neonates, but the women should be closely monitored for neonatal intraventricular hemorrhage.