RESUMEN
Introduction@#In the Philippines, hypertensive diseases of pregnancy belong in the top three causes of maternal mortality and complicate up to 10% of pregnancy worldwide. In relation with this, proper interventions must be given during the prenatal check-up to prevent occurrence that may cause feto-maternal mortality and morbidity. During prenatal check-up, pregnant women are given vitamin and mineral supplementations. Vitamin D has an association of having a risk for preeclampsia. Receptors of Vitamin D and 1-a hydroxylase are both expressed in the decidua and trophoblast cells. The active form of Vitamin D affects the transcription and function of genes associated with angiogenesis, invasion of the placenta, and normal implantation. The mechanisms mentioned are all involved in the pathophysiology of preeclampsia.@*Objectives@#The primary outcome of this study is to determine the association of Vitamin D supplementation in preeclampsia. Specifically, this study aims to compare the following secondary outcomes: Maternal outcomes (complication of gestational diabetes mellitus and underwent cesarean delivery) and fetal outcomes (preterm delivery and birth weight).@*Methodology@#Meta-analysis and systematic review of eight randomized controlled trials.@*Results@#Vitamin D reduced the risk of preeclampsia (risk ratio [RR] 0.45, 95% confidence interval [CI] 0.30–0.69; P = 0.0002). No significant difference on risk of gestational diabetes mellitus (RR 0.84, 95% CI 0.48–1.48) and risk of preterm delivery (RR 0.71, 95% CI 0.49–1.03). Results showed that newborns of mothers who had no Vitamin D supplementation had a higher birthweight (P = 0.010). No significant difference on cesarean section rate (RR 1.12, 95% CI 0.87–1.45).@*Conclusion@#Evidence suggests that Vitamin D supplementation can reduce the risk of preeclampsia. This study encourages obstetricians in our country to add Vitamin D supplementation as prenatal medication to prevent preeclampsia, thereby reducing maternal morbidity and mortality.
Asunto(s)
Preeclampsia , Vitamina DRESUMEN
Objectives@#The primary goal of this study is to determine if a single loading dose of Magnesium sulfate (MgSO4) is comparable to standard 24 hour therapy in preventing seizures with severe preeclampsia and eclampsia@*Study Design@#Metaanalysis and Systematic review of six randomized controlled trials @*Patients/Subject Selection@#Patients diagnosed with severe preeclampsia and eclampsia Intervention: Giving of single loading dose only (study group) versus 24-hour MgSO4 therapy (control) in patients with severe preeclampsia and eclampsia @*Outcome Measures@#(1) Anti-convulsant effects (2) Maternal: loss of deep tendon reflex and oliguria, incidences of caesarean section, Hemolysis, elevated liver enzymes, low platelet (HELLP) syndrome, post partum hemorrhage and intensive care unit admissions and (3) Neonatal complications: incidences of neonatal intensive care unit (NICU) admission, APGAR score at 5 minutes and death@*Results@#Occurrence of seizures was similar in both groups. The risk difference of -0.00 (95% Confidence interval (CI): -0.04 to 0.03; p=0.84) showed no significant difference and the combined studies were found to be homogenous with an I2 of 0.0. @*Conclusion@#A single loading dose of MgSO4 is comparable in preventing seizures of preeclamptic and eclamptic patients with similar maternal and neonatal complications except for a lesser occurrence of decreased patellar reflex in the study group (p=<000001).