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Evidence summaries

Diuretics for Preventing Pre-Eclampsia

Diuretics might possibly not be effective for preventing pre-eclampsia compared to placebo or no intervention, although there is insufficient evidence from controlled trials. Level of evidence: "D"

A Cochrane review [Abstract] 1 included 5 studies involving a total of 1836 women. Thiazide diuretics were compared with either placebo or no intervention and no clear differences for any reported pregnancy outcomes were found; pre-eclampsia (RR 0.68, 95%, CI 0.45 to 1.03, 4 trials, n=1391), perinatal death (RR 0.72, 95% CI 0.40 to 1.27, 5 trials, n=1836), and preterm birth (RR 0.67, 95% CI 0.32 to 1.41, 2 trials, n=465). Thiazide diuretics were associated with an increased risk of nausea and vomiting.

Comment: The quality of evidence is downgraded by study quality (inadequate reporting of randomisation and allocation concealment), by indirectness (differences in studied patients), by imprecise results (limited study size for each comparison and few outcome events), and by potential reporting bias (the most recent RCT was reported 22 years ago).

    References

    • Churchill D, Beevers GD, Meher S, Rhodes C. Diuretics for preventing pre-eclampsia. Cochrane Database Syst Rev 2007 Jan 24;(1):CD004451 [Review content assessed as up-to-date: 9 June 2010]. [PubMed]

Primary/Secondary Keywords