|Year : 2019 | Volume
| Issue : 1 | Page : 21
Effect of self-care before and during pregnancy to prevention and control preeclampsia in high-risk women
Masoumeh Rasouli1, Mahboubeh Pourheidari2, Zeinab Hamzeh Gardesh3
1 Master of Science in Counselingin Midwifery, Mazandaran Social Security Organization, Beheshahr Clinic, Beheshahr, Mazandaran Province, Iran
2 Department of Midwifery, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
3 Department of Midwifery, School of Nursing and Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran
|Date of Submission||11-Jul-2017|
|Date of Acceptance||12-Mar-2018|
|Date of Web Publication||12-Feb-2019|
Department of Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud
Source of Support: None, Conflict of Interest: None
Our aims to examine the factors influencing self-care for the prevention and control of preeclampsia in high-risk women. The current study is a review where the researcher browsed the available databases such as PubMed, Cochrane, Medline, Google Scholar, Medscape, and relevant research published between 1980 and 2016 were studied. To search for articles, relevant Medical Subject Heading keywords were first determined (Self-care, preeclampsia, prevention.) A total of 350 related articles were first selected, and the findings of 70 were used to compile the present article. The results of the study were classified under two general categories, including (1). Counseling and screening strategies and (2) self-care strategies for the prevention and control of preeclampsia in high-risk women. Screening women at risk for preeclampsia include measures such as measuring their blood pressure, checking for signs of depression, testing for thrombosis, taking a history of preeclampsia, providing preconception counseling about the appropriate age, time of pregnancy, and encouraging weight loss in obese women. This review showed a positive relationship between knowledge about self-care for preeclampsia and its control. The factors influencing preeclampsia self-care include making lifestyle changes, having a healthy diet, learning stress management, performing exercise and physical activities, taking antioxidants, dietary supplements, and calcium and adherence to aspirin and heparin regimens. There is a positive relationship between preconception counseling, screening women at risk for preeclampsia, self-care for the prevention, and control of preeclampsia. (1) Tweetable abstract self-care in high-risk women is strongly associated with prevention and control of preeclampsia.
Keywords: Preeclampsia, prevention and control, self-care
|How to cite this article:|
Rasouli M, Pourheidari M, Gardesh ZH. Effect of self-care before and during pregnancy to prevention and control preeclampsia in high-risk women. Int J Prev Med 2019;10:21
|How to cite this URL:|
Rasouli M, Pourheidari M, Gardesh ZH. Effect of self-care before and during pregnancy to prevention and control preeclampsia in high-risk women. Int J Prev Med [serial online] 2019 [cited 2020 Sep 28];10:21. Available from: http://www.ijpvmjournal.net/text.asp?2019/10/1/21/252144
| Introduction|| |
Preeclampsia is a pregnancy-specific syndrome characterized by hypertension and proteinuria that occurs after the 20th week of pregnancy in women who have had a normal blood pressure and no protein in their urine in the past., In the US, 15.9% of the cases of maternal mortality are caused by preeclampsia, and the condition is also considered the main cause of prenatal mortality and morbidity., About 1%–8% of Iranian women suffer from preeclampsia.
Gestational hypertension is one of the most common medical problems occurring during pregnancy. It is particularly important for pregnant women to be trained on this condition and to learn proper self-care for its prevention and control. Butler et al. reported that only 24% of women with gestational hypertension can manage their blood pressure. A study conducted in Uganda on women with normal blood pressure who suffered from preeclampsia and severe hypertension during their postpartum period found 64% of the women to have a high level of knowledge about pregnancy-induced hypertension; however, these women had no knowledge about self-care for this condition.
In India, Singh and Srivastava reported that 60.49% of women were uninformed about hypertension, and of all the women who agreed that a high salt intake is associated with hypertension, only 61.54% adhered to a low-salt diet.
Although studies have shown the positive effects of self-care on controlling pregnancy-induced hypertension, there is still a lack of comprehensive resources that can help pregnant women and health-care providers take effective measures to control and prevent gestational hypertension. The present study, therefore, aims to identify the factors influencing the control of preeclampsia in the domains of counseling, screening, and self-care in high-risk women and to provide endorsed solutions for improving maternal and neonatal health. It is now clear that the onset of the disease is multifactorial, and interventions for management of preeclampsia will necessarily have to address a wide range of factors through lifestyle and diet modification and multidisciplinary care.
| Methods|| |
The present narrative review was conducted in five main steps, including defining the research questions, identifying relevant research, selecting relevant articles, summarizing, and categorizing the results and reporting the results. The current study is a review where the researcher browsed the available databases such as PubMed, Cochrane, Medline, Google Scholar, Medscape, and relevant research published between 1980 and 2016 were studied. To search for articles, PubMed Medical Subject Heading (MeSH) and TEXTWORDS; using EMBASE subject headings and text words relevant MeSH keywords were first determined (Self-care, preeclampsia, prevention.) A total of 350 related articles were first selected and the findings of 70 were used to compile the present article [Figure 1].
|Figure 1: The effect of self-care before and during pregnancy to prevention and control preeclampsia in high-risk women|
Click here to view
| Results|| |
The results of this study can be classified under two general categories, including (1) counseling and screening strategies and (2) self-care strategies for the prevention of preeclampsia in high-risk women [Table 1] and [Table 2].
|Table 1: Counselling and screening strategies for the prevention of preeclampsia in high-risk women|
Click here to view
|Table 2: Self-care strategies for the prevention and control of preeclampsia in high-risk women|
Click here to view
| Discussion|| |
The results of the study showed that preconception counseling, screening, and self-care training can be effective in the prevention and control of preeclampsia in women at a high risk of this disease. The results are discussed in two general categories.
Counseling and screening strategies for the prevention and control of preeclampsia in high-risk women: The following section discusses some of the risk factors associated with preeclampsia and the counseling and screening strategies that can be taken to prevent and control them.
The risk factors associated with the incidence of preeclampsia
The appropriate age for pregnancy can affect the pregnancy outcomes. According to a study conducted in Taiwan, the prevalence of preeclampsia is associated with the mother's age. The lowest rate of preeclampsia was found to pertain to the 20–24 age group, and the prevalence of the condition was found to increase in the 35 and older age group. There was a significant relationship between pregnancy after the age of 35 and gestational hypertension., According to another study conducted in Iran (2011), the prevalence of eclampsia was reported as 6% in mothers aged <20 and 1.6% in mothers aged over 20, indicating a significant relationship between the mother's age and the relative frequency of eclampsia. Birth spacing is also associated with the incidence of preeclampsia. Skjaerven et al. found that with inter-pregnancy intervals of 10 years or more, the risk of preeclampsia in the second and third pregnancies is similar to that in nulliparous women. It is recommended for high-risk women to prevent pregnancy under the age of 20 and over the age of 35and to observe the recommended birth spacing.
Being overweight and obese
Obesity and excessive weight gain during pregnancy comprise one of the predictors of the development of preeclampsia.,, In Iran, Keshavarz and Babaee reported obesity as an independent factor responsible for the incidence of preeclampsia and gestational hypertension. Mostello et al. found that losing weight in the interpregnancy intervals reduces the risk of recurrent preeclampsia in women with a history of preeclampsia and concluded that these women need to be encouraged to lose weight. According to a study conducted in Haiti (2016), there was a significant relationship between high maternal weight and pregnancy-induced hypertensive disorders. Prepregnancy weight loss in obese and overweight women of reproductive age is, therefore, recommended as an easy and low-cost health intervention.
Seasonal and climatic factors
Preeclampsia is significantly more prevalent when conception occurs during the dry season. Wellington and Mulla and Shental et al. found that the incidence of preeclampsia increases during the cold season., In Sweden, the prevalence of preeclampsia during the winter was almost twice the rate during other seasons. A study conducted in Sudan (2015) reported the highest rate of preeclampsia to occur during the winter. Wacker et al. in Zimbabwe found that climate change plays an important role in the incidence of preeclampsia and reported the highest rate of preeclampsia to occur at the end of the dry season and at the beginning of the rainy season. In studies conducted by Subramaniam, Zahiri et al. and Phillips et al.,,, no relationship was found between the incidence of preeclampsia and the season.
Appropriate screening and counseling
The following items should be carefully considered in preeclampsia screening.
Blood pressure screening
Having a high blood pressure is one of the first signs of this disease. Blood pressure screening is also crucial for women with a history of preeclampsia during pregnancy. Gallo et al. reported the best means of screening for preeclampsia to be the measuring of the mean arterial pressure at both the 11th–13th and the 20th–24th weeks of pregnancy as compared to its measurement in only one of these periods. Blood pressure screening should be conducted more carefully in women with a history of gestational hypertension.
Screening for depression
Depression is a common condition developed during pregnancy. Qiu et al. found that the risk of preeclampsia during pregnancy is 2.3 higher in women with mild depression compared to those without depression while moderate-to-severe depression increases the risk of preeclampsia by 3.2. Kurki et al. reported depression to be associated with a 2.5 times higher risk of preeclampsia and anxiety with a 3.2 times higher risk. Given the high prevalence of depression and its relationship with several pregnancy complications, pregnant women are recommended to be screened for depression.
Screening for personal and family history
Having a history of preeclampsia constitutes an important risk factor for the recurrence of preeclampsia. Dalmáz et al. reported a family history of preeclampsia and chronic hypertension to be associated with the incidence of preeclampsia. Preeclampsia is more prevalent in women with mothers who have a history of preeclampsia compared to those who do not have such a family history. Onwudiwe et al. found that maternal characteristics, including ethnicity, parity, body mass index and personal and family history of preeclampsia, are known risk factors for the incidence of preeclampsia. According to a study conducted in Norway, the risk of preeclampsia was two times higher in pregnant women who had become pregnant from a man who had previously had another child from a previous wife with preeclampsia than in women whose sexual partners did not have such a history. Men who were themselves born from preeclamptic mothers have a two times higher chance of having children born from mothers with preeclampsia during their pregnancy compared to men who were born from normal pregnancies. Examining the personal and family history of preeclampsia in both men and women should therefore be a priority.
Screening for thrombophilia
One study found a significant relationship between the factor V Leiden mutation and the severity of preeclampsia. The risk of the recurrence of preeclampsia in the future pregnancies is higher in women with thrombotic defects, which is likely associated with hereditary thrombophilia. It is therefore recommended to screen for thrombophilia in white women with a history of preeclampsia as part of their preconception counseling and pregnancy management. Saghafi et al. found that the risk of thrombophilia is higher in preeclamptic women than in women with normal pregnancies. Screening for thrombosis, particularly in individuals with a hereditary history of the condition, is therefore highly recommended.
Screening urinary tract infection
The presence of urinary tract infection (UTI) in pregnancy, particularly in the third trimester, is strongly associated with preeclampsia. UTI screening in the first visit of the pregnant women and repeating it at the second and third trimester of pregnancy we could decrease adverse effects of UTI such as severe PE in pregnant women.
Self-care strategies for the prevention and control of preeclampsia in high-risk women
The knowledge of self-care for pregnancy-induced hypertension consists of an awareness about the skills that help prevent the incidence of the condition and includes a range of awareness on the part of the mother about the factors signaling gestational hypertension and the strategies for reducing or controlling blood pressure. A study conducted in Tanzania reported that 54% of women had some knowledge about gestational hypertension; however, none of them had any knowledge on self-care for the condition. Soya et al. conducted a study on nulliparous pregnant women in India found a clear relationship between knowledge about self-care and the actual control of blood pressure. The following section discusses some of the items that pregnant women need to be aware of and that health-care providers should emphasize when training women on self-care for gestational hypertension.
A study conducted in Iran (2013) recommends cognitive-behavioral stress management as a preferred treatment for reducing stress, anxiety, and depression in pregnant women. Jayashree et al. reported prenatal yoga as an effective technique for reducing gestational hypertension and preeclampsia. Leeners et al. found that mental stress during pregnancy was associated with a 1.6-fold increase in the risk of gestational hypertension. Mental stress levels are significantly higher in women with severe preeclampsia and hypertension than in women with mild gestational hypertension. There is a relationship between the loss of the baby and primary preeclampsia, and this relationship is strongest when the loss has occurred from 6 months before the pregnancy to the beginning of the second trimester of the pregnancy. Marcoux et al. found that women with a high job strain are 2.1 times more likely to develop preeclampsia than those with a lower job strain. In a study conducted by Vollebregt et al. in the Netherlands, job stress, anxiety, pregnancy-induced anxiety, and depression were found to have no effects on the incidence of preeclampsia or gestational hypertension. It is, therefore, essential for health-care providers to examine pregnant women's stress levels and to recommend practical strategies for stress management based on their particular stressors and conditions.
Nutritional status and dietary supplements
He following section thus reviews nutritional factors influencing the prevention and control of preeclampsia in women at the risk of developing the condition.
Various studies have recommended the increased consumption of fruits, vegetables, and vegetable oils, the regular consumption of folate and iron, the reduced consumption of fried foods, processed meat, and salty snacks and the avoidance of alcohol and caffeinated beverages as methods for the prevention of preeclampsia.,,,, Schoenaker et al. proposed the consumption of fruits, vegetables, and folate during pregnancy as independent variables contributing to the prevention of preeclampsia and considered anemia and high coffee consumption during pregnancy as some of the risk factors for the development of preeclampsia. Torjusen et al. in Norway, found women who consume organic vegetables “often” or “most often” are less likely to develop preeclampsia than women who consume these vegetables “sometimes”, “rarely” or “never”.
In a study (2003) reported a 75% reduction in the incidence of preeclampsia with the consumption of antioxidants. In the incidence of preeclampsia, refraining from a severe restriction on salt intake and an increased water intake are essential to maintaining a normal blood volume and the placental blood circulation.
The role of dietary supplements
According to a systematic review and a meta-analysis carried out by Tang et al. in Australia, calcium supplement consumption reduces the risk of developing preeclampsia, but further investigation is required to fully support this claim. In a meta-analysis of clinical trials conducted in China between 1991 and 2012, calcium supplements appear to be effective in reducing the risk of hypertension during pregnancy. Vadillo-Ortega et al. found that the use of antioxidant vitamin supplements in combination with L-arginine supplements during pregnancy reduce the incidence of preeclampsia significantly in women at the risk of developing the condition.
In a clinical trial in India, Sharma et al. reported the incidence of preeclampsia to be significantly lower in the group of women receiving lycopene than in the group of women receiving only placebos. According to a study conducted by Cohen et al. in Canada, there is a significant relationship between lutein levels and the general risk of developing preeclampsia.
Achkar et al. found that women with 25- hydroxyvitamin D levels lower than 30 n mol/L were 2.23 times more likely to develop preeclampsia than women with at least 50 n mol/L of 25- hydroxyvitamin D. According to a systematic review conducted in Pakistan, Arain et al. found a positive relationship between Vitamin D deficiency and preeclampsia in more than half of the studies reviewed. Several studies have been conducted on the effect of fish oil supplements on the prevention and incidence of preeclampsia. According to a meta-analysis conducted by Chen et al., the benefits of using fish oil supplements in reducing the risk of developing preeclampsia and pregnancy-induced hypertension is not yet confirmed.
The role of using iron and folic acid supplements and multivitamins
In Denmark (2009), the regular consumption of folic acid and multivitamins before pregnancy and immediately after conception in women with a healthy weight is associated with a reduction in the mean incidence of preeclampsia. Agrawal et al. in India reported that a diet rich in iron and folic acid is associated with a significant reduction in the symptoms of preeclampsia and eclampsia. In a clinical trial conducted in Canada (2013), using folic acid supplements (4 mg doses of folic acid from the 8–16th week of pregnancy until the date of delivery) is effective in the prevention of preeclampsia and its side effects. Saccone et al. in Italy found that women who received 5-methyltetrahydrofolate during the first trimester of pregnancy had a significantly lower incidence of recurrent preeclampsia, severe preeclampsia, and early-onset preeclampsia.
The role of complementary medicine and traditional Chinese medicine
In Chinese medicine, a diet that helps develop a healthy vital blood circulation and strengthen the energy channels also supports the tonicity of the growing uterus. In a systematic review, however, Zhang et al. argued that no clinical trials have ever been conducted on this subject and the effectiveness of traditional Chinese medicine in the treatment of preeclampsia is therefore still uncertain. In a cross-sectional study conducted in Taiwan, Yeh et al. reported that traditional Chinese medicine is becoming increasingly popular among pregnant women in Taiwan for the treatment of problems associated with pregnancy-induced hypertension and morning sickness. The effectiveness of traditional Chinese medicine in the treatment of preeclampsia is still unclear.
In a study in Norway (2008), Women who had regular physical activity showed a 20% reduction in the incidence of preeclampsia. According to a study.(2005) in New York, pregnant women who had a high level of physical activity during the year preceding their pregnancy were 78% less likely to develop preeclampsia compared to women who did not exercise at all or who had low levels of physical activity during this exact period. Kasawara et al. found that physical exercise has a protective effect against preeclampsia.
According to a clinical trial (2008) conducted in North Carolina on pregnant women with a history of preeclampsia in the previous pregnancies who also led sedentary lifestyles, walking was found to have no harmful effects during pregnancy; however, for women who were at a higher risk of developing preeclampsia, stretching exercises may have a better protective effect against the condition. Kasawara et al. examined pregnant women with chronic hypertension and a history of preeclampsia who used stationary bicycles once a week for 30 min under the supervision of an expert and compared them to the study's control group and argued that this exercise routine is not associated with an increased risk of maternal and neonatal complications and does not interfere with the type of delivery either.
Recreational physical activities, stretching exercises, walking, using stationary bicycles, and modifying the sedentary lifestyle are other measures recommended for the control and prevention of this condition.
Adherence to the medical regimen and the prenatal care routine
Low doses of aspirin and calcium supplements are known as the only definite ways for reducing the incidence of gestational hypertension. Antiplatelet compounds are also associated with a 17% reduction in the risk of the incidence of preeclampsia. In a study conducted in Canada, (2013) found that the use of low-dose aspirin at or before the 16th week of pregnancy in women at the risk of preeclampsia reduces the risk of developing severe preeclampsia and gestational hypertension. A clinical trial conducted in India (2014) found that the combined use of low-dose aspirin and antioxidants is associated with a reduced incidence of pregnancy-induced hypertension and preeclampsia. In a meta-analysis, Bujold et al. found that using aspirin the 16th week of pregnancy is associated with a 52% reduction in the risk of developing preeclampsia compared to when using aspirin after the 16th week of pregnancy. According to a 5-year review study, women with gestational hypertensive disorders made significantly fewer prenatal care visits. Developing policies to encourage pregnant women at a high risk for preeclampsia to adhere to their medical regimen and to make regular and more frequent doctors' visits is, therefore, highly recommended.
| Conclusions|| |
There is a positive relationship between preconception counseling, screening women at the risk of developing preeclampsia, knowledge about self-care for gestational hypertension, and the prevention and control of preeclampsia.
Financial support and sponsorship
This project was funded and supported by the Student Research Committee, Shahroud University of Medical Sciences.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Minds A. Possible Worlds. Cambridge, MA: Harvard UP; 1986.
Webb TL, Joseph J, Yardley L, Michie S. Using the internet to promote health behavior change: A systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res 2010;12:e4.
Whitehead SJ, Berg CJ, Chang J. Pregnancy-related mortality due to cardiomyopathy: United states, 1991-1997. Obstet Gynecol 2003;102:1326-31.
Duley L. Pre-eclampsia and the hypertensive disorders of pregnancy. Br Med Bull 2003;67:161-76.
López-Jaramillo P, Casas JP, Serrano N. Preeclampsia: From epidemiological observations to molecular mechanisms. Braz J Med Biol Res 2001;34:1227-35.
Butler R, Morris AD, Burchell B, Struthers AD. DD angiotensin-converting enzyme gene polymorphism is associated with endothelial dysfunction in normal humans. Hypertension 1999;33:1164-8.
Atterbury JL, Groome LJ, Hoff C. Blood pressure changes in normotensive women readmitted in the postpartum period with severe preeclampsia/eclampsia. J Matern Fetal Med 1996;5:201-5.
Singh V, Srivastava M. Associated risk factors with pregnancy-induced hypertension: A hospital-based KAP study. International J Medicine and Public Health 2015;5:5,1,59-62.
Chan TF, Tung YC, Wang SH, Lee CH, Lin CL, Lu PY, et al.
Trends in the incidence of pre-eclampsia and eclampsia in Taiwan between 1998 and 2010. Taiwan J Obstet Gynecol 2015;54:270-4.
Sekkarie A, Raskind-Hood C, Hogue C. The effects of maternal weight and age on pre-eclampsia and eclampsia in Haiti. J Matern Fetal Neonatal Med 2016;29:602-6.
Sohrabi D, Rostami H. Impact of maternal age on pregnancy outcome. J Urmia Nursing And Midwifery Faculty 2008;6:79-85.
Fadaei B, Movahedi M, Akbari M, Ghasemi M, Jalalvand A. Effect of maternal age on pregnancy outcome. J Isfahan Medical School 2011;29(145).
Skjaerven R, Wilcox AJ, Lie RT. The interval between pregnancies and the risk of preeclampsia. N Engl J Med 2002;346:33-8.
Sibai BM, Gordon T, Thom E, Caritis SN, Klebanoff M, McNellis D, et al.
Risk factors for preeclampsia in healthy nulliparous women: A prospective multicenter study. The National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Am J Obstet Gynecol 1995;172:642-8.
Stone JL, Lockwood CJ, Berkowitz GS, Alvarez M, Lapinski R, Berkowitz RL, et al.
Risk factors for severe preeclampsia. Obstet Gynecol 1994;83:357-61.
Eskenazi B, Fenster L, Sidney S. A multivariate analysis of risk factors for preeclampsia. JAMA 1991;266:237-41.
Mostello D, Jen Chang J, Allen J, Luehr L, Shyken J, Leet T, et al.
Recurrent preeclampsia: The effect of weight change between pregnancies. Obstet Gynecol 2010;116:667-72.
Pitakkarnkul S, Phaloprakarn C, Wiriyasirivaj B, Manusirivithaya S, Tangjitgamol S. Seasonal variation in the prevalence of preeclampsia. J Med Assoc Thai 2011;94:1293-8.
Wellington K, Mulla ZD. Seasonal trend in the occurrence of preeclampsia and eclampsia in texas. Am J Hypertens 2012;25:115-9.
Shental O, Friger M, Sheiner E. Ethnic differences in the monthly variation of preeclampsia among bedouin and jewish parturients in the negev. Hypertens Pregnancy 2010;29:342-9.
Rylander A, Lindqvist PG. Eclampsia is more prevalent during the winter season in sweden. Acta Obstet Gynecol Scand 2011;90:114-7.
Ali AA, Adam GK, Abdallah TM. Seasonal variation and hypertensive disorders of pregnancy in Eastern Sudan. J Obstet Gynaecol 2015;35:153-4.
Wacker J, Schulz M, Frühauf J, Chiwora FM, Solomayer E, Bastert G, et al.
Seasonal change in the incidence of preeclampsia in Zimbabwe. Acta Obstet Gynecol Scand 1998;77:712-6.
Zahiri Z, Gharami H, Faraji R. Seasonal variation of the onset of preeclampsia and eclampsia. J Res Med Sci 2007;12:198-202.
Subramaniam V. Seasonal variation in the incidence of preeclampsia and eclampsia in tropical climatic conditions. BMC Womens Health 2007;7:18.
Phillips JK, Bernstein IM, Mongeon JA, Badger GJ. Seasonal variation in preeclampsia based on timing of conception. Obstet Gynecol 2004;104:1015-20.
Barton JR, Sibai BM. Prediction and prevention of recurrent preeclampsia. Obstet Gynecol 2008;112:359-72.
Gallo D, Poon LC, Fernandez M, Wright D, Nicolaides KH. Prediction of preeclampsia by mean arterial pressure at 11-13 and 20-24 weeks' gestation. Fetal Diagn Ther 2014;36:28-37.
Qiu C, Sanchez SE, Lam N, Garcia P, Williams MA. Associations of depression and depressive symptoms with preeclampsia: Results from a peruvian case-control study. BMC Womens Health 2007;7:15.
Kurki T, Hiilesmaa V, Raitasalo R, Mattila H, Ylikorkala O. Depression and anxiety in early pregnancy and risk for preeclampsia. Obstet Gynecol 2000;95:487-90.
Dalmáz CA, Santos KG, Botton MR, Roisenberg I. Risk factors for hypertensive disorders of pregnancy in Southern Brazil. Rev Assoc Med Bras (1992) 2011;57:692-6.
Chesley LC. Hypertension in pregnancy: Definitions, familial factor, and remote prognosis. Kidney Int 1980;18:234-40.
Onwudiwe N, Yu CK, Poon LC, Spiliopoulos I, Nicolaides KH. Prediction of pre-eclampsia by a combination of maternal history, uterine artery doppler and mean arterial pressure. Ultrasound Obstet Gynecol 2008;32:877-83.
Lie RT, Rasmussen S, Brunborg H, Gjessing HK, Lie-Nielsen E, Irgens LM, et al.
Fetal and maternal contributions to risk of pre-eclampsia: Population based study. BMJ 1998;316:1343-7.
Esplin MS, Fausett MB, Fraser A, Kerber R, Mineau G, Carrillo J, et al.
Paternal and maternal components of the predisposition to preeclampsia. N Engl J Med 2001;344:867-72.
Dizon-Townson DS, Nelson LM, Easton K, Ward K. The factor V leiden mutation may predispose women to severe preeclampsia. Am J Obstet Gynecol 1996;175:902-5.
Facchinetti F, Marozio L, Frusca T, Grandone E, Venturini P, Tiscia GL, et al.
Maternal thrombophilia and the risk of recurrence of preeclampsia. Am J Obstet Gynecol 2009;200:46.e1-5.
Saghafi N, Mohammadzadeh Vatanchi A, Tara F, Pourali L, Dadgar S. Evaluation of selected thrombotic factors among pregnant women with preeclampsia and normal pregnant women. Iran J Reprod Med 2014;12:793-8.
Easter SR, Cantonwine DE, Zera CA, Lim KH, Parry SI, McElrath TF, et al.
Urinary tract infection during pregnancy, angiogenic factor profiles, and risk of preeclampsia. Am J Obstet Gynecol 2016;214:387.e1-7.
Izadi B, Rostami-Far Z, Jalilian N, Khazaei S, Amiri A, Madani SH, et al
. Urinary tract infection (UTI) as a risk factor of severe preeclampsia. Glob J Health Sci 2016;8:54364.
Pswarayi I. The Relationship between Pregnancy Induced Hypertension (PIH) Self Care Knowledge and Hypertension Control among Pregnant Mothers Aged 18 to 49 Years in Bindura District: University of Zimbabwe; 2010.
Soya K, Kumari VP, Mumthas K. Self-care activities of pregnancy induced hypertension and maternal outcome. Nurs J India 2003;94:58-60.
Hashemi H, Jabari Z, Haghayegh S. Survey on effectiveness of cognitive behavioral stress management on the stress, anxiety, and depression of pregnant women. J Res Health Syst 2013;8:1341-7.
Jayashree R, Malini A, Rakhshani A, Nagendra H, Gunasheela S, Nagarathna R, et al.
Effect of the integrated approach of yoga therapy on platelet count and uric acid in pregnancy: A multicenter stratified randomized single-blind study. Int J Yoga 2013;6:39-46.
] [Full text]
Leeners B, Neumaier-Wagner P, Kuse S, Stiller R, Rath W. Emotional stress and the risk to develop hypertensive diseases in pregnancy. Hypertens Pregnancy 2007;26:211-26.
Black KD. Stress, symptoms, self-monitoring confidence, well-being, and social support in the progression of preeclampsia/gestational hypertension. J Obstet Gynecol Neonatal Nurs 2007;36:419-29.
László KD, Liu XQ, Svensson T, Wikström AK, Li J, Olsen J, et al.
Psychosocial stress related to the loss of a close relative the year before or during pregnancy and risk of preeclampsia. Hypertension 2013;62:183-9.
Marcoux S, Bérubé S, Brisson C, Mondor M. Job strain and pregnancy-induced hypertension. Epidemiology 1999;10:376-82.
Vollebregt KC, van der Wal MF, Wolf H, Vrijkotte TG, Boer K, Bonsel GJ, et al.
Is psychosocial stress in first ongoing pregnancies associated with pre-eclampsia and gestational hypertension? BJOG 2008;115:607-15.
Torjusen H, Brantsæter AL, Haugen M, Alexander J, Bakketeig LS, Lieblein G, et al.
Reduced risk of pre-eclampsia with organic vegetable consumption: Results from the prospective norwegian mother and child cohort study. BMJ Open 2014;4:e006143.
Dodd JM, O'Brien C, Grivell RM. Preventing pre-eclampsia – Are dietary factors the key? BMC Med 2014;12:176.
McCarthy FP, O'Keeffe LM, Khashan AS, North RA, Poston L, McCowan LM, et al.
Association between maternal alcohol consumption in early pregnancy and pregnancy outcomes. Obstet Gynecol 2013;122:830-7.
Brantsaeter AL, Haugen M, Samuelsen SO, Torjusen H, Trogstad L, Alexander J, et al.
Adietary pattern characterized by high intake of vegetables, fruits, and vegetable oils is associated with reduced risk of preeclampsia in nulliparous pregnant Norwegian women. J Nutr 2009;139:1162-8.
Williams MA, Zingheim RW, King IB, Zebelman AM. Omega-3 fatty acids in maternal erythrocytes and risk of preeclampsia. Epidemiology 1995;6:232-7.
Schoenaker DA, Soedamah-Muthu SS, Mishra GD. The association between dietary factors and gestational hypertension and pre-eclampsia: A systematic review and meta-analysis of observational studies. BMC Med 2014;12:157.
Merialdi M, Carroli G, Villar J, Abalos E, Gülmezoglu AM, Kulier R, et al.
Nutritional interventions during pregnancy for the prevention or treatment of impaired fetal growth: An overview of randomized controlled trials. J Nutr 2003;133:1626S-31S.
Tang R, Tang IC, Henry A, Welsh A. Limited evidence for calcium supplementation in preeclampsia prevention: A meta-analysis and systematic review. Hypertens Pregnancy 2015;34:181-203.
An LB, Li WT, Xie TN, Peng X, Li B, Xie SH, et al.
Calcium supplementation reducing the risk of hypertensive disorders of pregnancy and related problems: A meta-analysis of multicentre randomized controlled trials. Int J Nurs Pract 2015;21 Suppl 2:19-31.
Vadillo-Ortega F, Perichart-Perera O, Espino S, Avila-Vergara MA, Ibarra I, Ahued R, et al.
Effect of supplementation during pregnancy with L-arginine and antioxidant vitamins in medical food on pre-eclampsia in high risk population: Randomised controlled trial. BMJ 2011;342:d2901.
Sharma JB, Kumar A, Kumar A, Malhotra M, Arora R, Prasad S, et al.
Effect of lycopene on pre-eclampsia and intra-uterine growth retardation in primigravidas. Int J Gynaecol Obstet 2003;81:257-62.
Cohen JM, Kramer MS, Platt RW, Basso O, Evans RW, Kahn SR, et al.
The association between maternal antioxidant levels in midpregnancy and preeclampsia. Am J Obstet Gynecol 2015;213:695.e1-13.
Achkar M, Dodds L, Giguère Y, Forest JC, Armson BA, Woolcott C, et al.
Vitamin D status in early pregnancy and risk of preeclampsia. Am J Obstet Gynecol 2015;212:511.e1-7.
Arain N, Mirza WA, Aslam M. Review-Vitamin D and the prevention of preeclampsia: A systematic review. Pak J Pharm Sci 2015;28:1015-21.
Chen B, Ji X, Zhang L, Hou Z, Li C, Tong Y. Fish oil supplementation does not reduce risks of gestational diabetes mellitus, pregnancy-induced hypertension, or pre-eclampsia: A meta-analysis of randomized controlled trials. Med Sci Monit 2015;21:2322.
Catov JM, Nohr EA, Bodnar LM, Knudson VK, Olsen SF, Olsen J, et al.
Association of periconceptional multivitamin use with reduced risk of preeclampsia among normal-weight women in the Danish National Birth Cohort. Am J Epidemiol 2009;169:1304-11.
Agrawal S, Fledderjohann J, Vellakkal S, Stuckler D. Adequately diversified dietary intake and iron and folic acid supplementation during pregnancy is associated with reduced occurrence of symptoms suggestive of pre-eclampsia or eclampsia in Indian women. PLoS One 2015;10:e0119120.
Wen SW, Champagne J, Rennicks White R, Coyle D, Fraser W, Smith G, et al.
Effect of folic acid supplementation in pregnancy on preeclampsia: The folic acid clinical trial study. J Pregnancy 2013;2013:294312.
Saccone G, Sarno L, Roman A, Donadono V, Maruotti GM, Martinelli P, et al
. 5-methyl-tetrahydrofolate in prevention of recurrent preeclampsia. J Matern Fetal Neonatal Med 2016;29:916-20.
Zhang J, Wu TX, Liu GJ. Chinese herbal medicine for the treatment of pre-eclampsia. Cochrane Database Syst Rev 2006;(2):CD005126.
Yeh HY, Chen YC, Chen FP, Chou LF, Chen TJ, Hwang SJ, et al.
Use of traditional Chinese medicine among pregnant women in Taiwan. Int J Gynaecol Obstet 2009;107:147-50.
Magnus P, Trogstad L, Owe KM, Olsen SF, Nystad W. Recreational physical activity and the risk of preeclampsia: A prospective cohort of Norwegian women. Am J Epidemiol 2008;168:952-7.
Rudra CB, Williams MA, Lee IM, Miller RS, Sorensen TK. Perceived exertion during prepregnancy physical activity and preeclampsia risk. Med Sci Sports Exerc 2005;37:1836-41.
Kasawara KT, do Nascimento SL, Costa ML, Surita FG, e Silva JL. Exercise and physical activity in the prevention of pre-eclampsia: Systematic review. Acta Obstet Gynecol Scand 2012;91:1147-57.
Yeo S, Davidge S, Ronis DL, Antonakos CL, Hayashi R, O'Leary S, et al.
Acomparison of walking versus stretching exercises to reduce the incidence of preeclampsia: A randomized clinical trial. Hypertens Pregnancy 2008;27:113-30.
Kasawara KT, Burgos CS, do Nascimento SL, Ferreira NO, Surita FG, Pinto E Silva JL, et al.
Maternal and perinatal outcomes of exercise in pregnant women with chronic hypertension and/or previous preeclampsia: A randomized controlled trial. ISRN Obstet Gynecol 2013;2013:857047.
Duley L1, Henderson-Smart DJ, Meher S, King JF. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev 2007;(2):CD004659.
Hofmeyr GJ, Lawrie TA, Atallah AN, Duley L. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev 2010;(8):CD001059.
Roberge S, Nicolaides KH, Demers S, Villa P, Bujold E. Prevention of perinatal death and adverse perinatal outcome using low-dose aspirin: A meta-analysis. Ultrasound Obstet Gynecol 2013;41:491-9.
Vyas KM, Vyas AK. The study of role of aspirin and antioxidants in prevention of hypertensive disorders in primigravidas. Int J Biomed Adv Res 2014;5:595-9.
Bujold E, Morency AM, Roberge S, Lacasse Y, Forest JC, Giguère Y, et al.
Acetylsalicylic acid for the prevention of preeclampsia and intra-uterine growth restriction in women with abnormal uterine artery doppler: A systematic review and meta-analysis. J Obstet Gynaecol Can 2009;31:818-26.
Tomić V, Petrović O, Petrov B, Bjelanović V, Naletilić M. Hypertensive disorders in pregnancy: A 5-year analysis of the wartime and postwar period in south-western region of Bosnia and Herzegovina. Coll Antropol 2009;33 Suppl 2:115-9.
[Table 1], [Table 2]