目的：确定降低与先兆子痫相关的孕产妇和新生儿发病率的策略。
方法：按照GRADE®方法评估文献的证据质量，并以PICO格式（患者，干预,比较,结果)和结果先验定义，并根据其重要性进行分类。在PubMed上进行了广泛的书目搜索，科克伦,EMBASE和谷歌学者数据库。评估了证据的质量(高，中度,低,非常低)，并且建议被制定为(I)强，(ii)弱或(iii)无建议。与外部审稿人（Delphi调查）在两轮中对建议进行了审查，以选择共识建议。
结果：先兆子痫的定义是妊娠高血压（收缩压≥140mmHg和/或舒张压≥90mmHg）和蛋白尿≥0.3g/24h或蛋白尿/Creatinua比值≥30mg/mmol。来自文献的数据没有显示实施更广泛的先兆子痫定义在孕产妇或围产期健康方面的任何益处。在31个问题中，工作组和外部审稿人就31人(100%)达成协议。在一般人口中,应鼓励怀孕期间进行体育锻炼，以降低先兆子痫的风险（强烈推荐，证据质量低)，但基于算法的早期筛查(弱推荐，证据质量低)或阿司匹林给药(弱推荐，证据质量非常低）不建议降低与先兆子痫相关的孕产妇和新生儿发病率。在患有糖尿病或高血压或肾脏疾病的女性中，或者多胎妊娠,证据水平不足以确定怀孕期间服用阿司匹林是否有助于降低孕产妇和围产期发病率(无推荐，证据质量低)。在有血管胎盘疾病史的女性中，低剂量阿司匹林（强烈推荐，证据质量适中），剂量为每天100-160mg（推荐较弱，证据质量低)，理想情况下是在妊娠16周前，而不是妊娠20周后(强烈推荐，证据质量低）直到妊娠36周（弱推荐，证据质量非常低)建议。在高风险人群中，不推荐额外服用低分子量肝素(弱推荐，证据质量适中)。在先兆子痫的情况下（弱推荐，证据质量低)或怀疑先兆子痫(弱推荐，证据质量适中，不建议常规评估PlGF浓度或sFLT-1/PlGF比率），这是降低孕产妇或围产期发病率的唯一目标。在非重度先兆子痫的女性中，当收缩压在140至159mmHg之间或舒张压在90至109mmHg之间时，应口服抗高血压药（弱推荐，证据质量低)。在非重度先兆子痫的女性中，妊娠34~36+6周分娩可降低重度产妇高血压,但增加中度早产的发生率.考虑到母亲和孩子的利益/风险平衡，建议不要在妊娠34至36+6周的非重度先兆子痫妇女中系统地引产（强烈推荐，证据质量高)。在妊娠37+0至41周诊断为非重度先兆子痫的女性中，建议诱导分娩以降低产妇发病率(强烈推荐，证据质量低)，并在没有禁忌症的情况下进行劳动试验(强烈推荐，证据质量很低)。在有先兆子痫病史的女性中，不建议筛查母体血栓形成倾向(强烈推荐，证据质量适中)。因为有先兆子痫病史的女性患慢性高血压和心血管并发症的终身风险增加，应告知他们需要进行医学随访以监测血压和管理其他可能的心血管危险因素（强烈推荐，证据质量适中)。
结论：这些建议的目的是重新评估先兆子痫的定义，并确定减少与先兆子痫相关的孕产妇和围产期发病率的策略，在怀孕期间以及分娩后。他们的目的是帮助卫生专业人员在日常临床实践中告知或护理患有或患有先兆子痫的患者。还为专业人员和患者提供合成信息文档。
To identify strategies to reduce maternal and neonatal morbidity related to preeclampsia.
The quality of evidence of the literature was assessed following the GRADE® method with questions formulated in the PICO format (Patients, Intervention, Comparison, Outcome) and outcomes defined a priori and classified according to their importance. An extensive bibliographic search was performed on PubMed, Cochrane, EMBASE and Google Scholar databases. The quality of the evidence was assessed (high, moderate, low, very low) and recommendations were formulated as a (i) strong, (ii) weak or (iii) no recommendation. The recommendations were reviewed in two rounds with external reviewers (Delphi survey) to select the
consensus recommendations.
Preeclampsia is defined by the association of gestational hypertension (systolic blood pressure≥140mmHg and/or diastolic blood pressure≥90mmHg) and proteinuria≥0.3g/24h or a Proteinuria/Creatininuria ratio≥30mg/mmol occurring after 20 weeks of gestation. Data from the literature do not show any benefit in terms of maternal or perinatal health from implementing a broader definition of preeclampsia. Of the 31 questions, there was agreement between the working group and the external reviewers on 31 (100%). In general population, physical activity during pregnancy should be encouraged to reduce the risk of preeclampsia (Strong recommendation, Quality of the evidence low) but an early screening based on algorithms (Weak recommendation, Quality of the evidence low) or aspirin administration (Weak recommendation, Quality of the evidence very low) is not recommended to reduce maternal and neonatal morbidity related to preeclampsia. In women with preexisting diabetes or hypertension or renal disease, or multiple pregnancy, the level of evidence is insufficient to determine whether aspirin administration during pregnancy is useful to reduce maternal and perinatal morbidity (No recommendation, Quality of the evidence low). In women with a history of vasculo-placental disease, low dose of aspirin (Strong recommendation, Quality of the evidence moderate) at a dosage of 100-160mg per day (Weak recommendation, Quality of the evidence low), ideally before 16 weeks of gestation and not after 20 weeks of gestation (Strong recommendation, Quality of the evidence low) until 36 weeks of gestation (Weak recommendation, Quality of the evidence very low) is recommended. In a high-risk population, additional administration of low molecular weight heparin is not recommended (Weak recommendation, Quality of the evidence moderate). In case of preeclampsia (Weak recommendation, Quality of the evidence low) or suspicion of preeclampsia (Weak recommendation, Quality of the evidence moderate, the assessment of PlGF concentration or sFLT-1/PlGF ratio is not routinely recommended) in the only goal to reduce maternal or perinatal morbidity. In women with non-severe preeclampsia antihypertensive agent should be administered orally when the systolic blood pressure is measured between 140 and 159mmHg or diastolic blood pressure is measured between 90 and 109mmHg (Weak recommendation, Quality of the evidence low). In women with non-severe preeclampsia, delivery between 34 and 36+6 weeks of gestation reduces severe maternal hypertension but increases the incidence of moderate prematurity. Taking into account the benefit/risk balance for the mother and the child, it is recommended not to systematically induce birth in women with non-severe preeclampsia between 34 and 36+6 weeks of gestation (Strong recommendation, Quality of evidence high). In women with non-severe preeclampsia diagnosed between 37+0 and 41 weeks of gestation, it is recommended to induce birth to reduce maternal morbidity (Strong recommendation, Low quality of evidence), and to perform a trial of labor in the absence of contraindication (Strong recommendation, Very low quality of evidence). In women with a history of preeclampsia, screening maternal thrombophilia is not recommended (Strong recommendation, Quality of the evidence moderate). Because women with a history of a preeclampsia have an increased lifelong risk of chronic hypertension and cardiovascular complications, they should be informed of the need for medical follow-up to monitor blood pressure and to manage other possible cardiovascular risk factors (Strong recommendation, Quality of the evidence moderate).
The purpose of these recommendations was to reassess the definition of preeclampsia, and to determine the strategies to reduce maternal and perinatal morbidity related to preeclampsia, during pregnancy but also after childbirth. They aim to help health professionals in their daily clinical practice to inform or care for patients who have had or have preeclampsia. Synthetic information documents are also offered for professionals and patients.
