title: Prevention of Hypertensive Disorders of Pregnancy: a Novel Application of the Polypill Concept.
abstract: Nearly all of the annual 287,000 global maternal deaths are preventable. Hypertensive disorders of pregnancy (HDP) are among the major causes. A novel fixed-dose combination pill or polypill to prevent cardiovascular disease is a promising strategy for prevention of HDP. The aim of this study was to identify eligible candidates for a polypill for the prevention of HDP. A comprehensive review of systematic reviews on drug and dietary interventions to prevent HDP was conducted. Interventions were evaluated based on efficacy, dose, route of administration, and side effects. Fourteen interventions were assessed. Low-dose aspirin and calcium were identified as candidates for a polypill, with risk reduction estimations for pregnancy-induced hypertension and preeclampsia ranging between 10 and 62 %, depending on patient population characteristics including a priori risk, and gestation age at start of intervention. Their effect may be augmented through the addition of vitamin D, vitamin B12, and folic acid. The effect and optimal composition needs to be evaluated in future trials. Given the persistent burden of maternal and perinatal mortality associated with HDP, prevention of these disorders is key-especially in low-resource settings. The polypill approach with a combination of aspirin, calcium, vitamin D, vitamin B12, and folic acid is a promising strategy to improve maternal and perinatal health outcomes.
authors.affiliation: Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands. J.L.Browne@umcutrecht.nl.
authors.forename: J L
authors.initials: JL
authors.lastname: Browne
authors.affiliation: Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.|Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: K
authors.initials: K
authors.lastname: Klipstein-Grobusch
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Franx
authors.affiliation: Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
authors.forename: D E
authors.initials: DE
authors.lastname: Grobbee
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D002136:Calcium, Dietary / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000517:prevention & control* / Q000628:therapy; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000517:prevention & control* / Q000628:therapy; D016896:Treatment Outcome; D014805:Vitamin B 12 / Q000627:therapeutic use*; D014803:Vitamin B Complex / Q000627:therapeutic use; D014807:Vitamin D / Q000627:therapeutic use*; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D000959:Antihypertensive Agents; D002136:Calcium, Dietary; D014815:Vitamins; D014803:Vitamin B Complex; D014807:Vitamin D; D014805:Vitamin B 12; D001241:Aspirin
keywords: Hypertensive disorders; Polypill; Pregnancy