Interventions to prevent pregnancy-induced hypertension: a systematic review and network meta-analysis

Abstract Objective A network meta-analysis based on randomized controlled trials was conducted to investigate the effects of different interventions in preventing pregnancy-induced hypertension. Methods English databases were searched for randomized controlled trials reporting different interventions in preventing pregnancy-induced hypertension. The risk of bias for the included trials was assessed using the Cochrane Handbook tool. Stata 15.1 software was used to perform network meta-analysis. Results A total of 47 studies involving 57,836 pregnant women were included in the network meta-analysis. For all included trials, 14 interventions were reported, which yielded 91 pairs of comparisons. The network meta-analysis showed that compared with Usual-care, interventions could significantly lower the incidence of hypertensive disorders of pregnancy, including yoga (odds ratio (OR) = 0.10, 95% confidence interval (CI) [0.02, 0.52]) and walking (OR = 0.51, 95% CI [0.27, 0.95]). Moreover, Yoga (OR = 0.11, 95% CI [0.02, 0.95]) and calcium supplementation (OR = 0.71, 95% CI [0.53, 0.94]) were superior to placebo in the prevention of pregnancy-induced hypertension. Finally, the surface under the cumulative ranking curve revealed that yoga had the highest probability of becoming the best intervention. Conclusions Maternal exercise (yoga and walking) or calcium supplementation might be the preventative tools for pregnancy-induced hypertension. However, given the limited number of trials and potential heterogeneity, more high-quality trials are needed to confirm the current findings.