Prospective directions for creating a strategy for effective medicine prevention of preeclampsia (Literature review)

Abstract

Preeclampsia (PE) is a main cause of morbidity and mortality for both mother and fetus. The frequency of PE is from 2 % to 8 %. The complications which are related to PE lead to more than 50,000 maternal deaths and more than 500,000 fetal deaths worldwide each year. In Ukraine, PE was diagnosed in 11,075 women in 2020 (39.32 per 1,000 births), of which severe PE was diagnosed in 1,573 women (5.58 per 1,000 births).The advances in obstetrics and neonatology have significantly mitigated many adverse pregnancy outcomes associated with PE. The optimal prevention of PE is essential to prevent the morbidity and mortality associated with this pathology. The number of researches about new management for the prevention or treatment of PE and new drugs that can affect the pathophysiology of the disease increases. The main value of potential candidates for the prevention of PE is the preclinical impact on oxidative stress, antiangiogenic factors, as well as thrombogenic potential and proinflammatory pathways of pathology development. A systematic data search was carried out in MEDLINE, ISI Web of Science, PubMed, Scopus, Google Scholar and Proquest databases for 2014–2022. In this review, the results of preclinical and clinical studies about the rational prevention of the development of PE in pregnant women at risk with the involvement of the most promising drugs were analyzed. Preclinical studies have suggested new molecular targeting strategies, such as monoclonal antibodies directed against tumor necrosis factor alpha, placental growth factor, and short interfering ribonucleic acid technology to inhibit soluble fms-like tyrosine kinase-1 or angiotensinogen gene expression. Other treatment approaches that have progressed to phase III trials (either completed or ongoing) include proton pump inhibitors, metformin, nitric oxide donors and precursors, recombinant antithrombin III, digoxin immune antigen, and melatonin. There are cases suggesting that deletion of circulating soluble fms-like tyrosine kinase-1 can help to stabilize PE and prolong pregnancy.