A Systematic Review of Proton Pump Inhibitors for the Prevention and Treatment of Preeclampsia and Gestational Hypertension

Background: Preeclampsia is a hypertensive disorder of pregnancy with a high rate of neonatal and maternal morbidity and mortality.The only definitive treatment is delivery.Through pre-clinical studies, proton pump inhibitors (PPIs), which are commonly and safely used in pregnancy, have been identified as potential therapeutic agents.Objective: To undertake a systematic review evaluating PPIs in the prevention and/or treatment of preeclampsia and gestational hypertension.Search strategy: Electronic databases were searched from inception to 2018.Search terms included preeclampsia, proton-pump inhibitors, pregnancy-induced hypertension, lansoprazole, rabeprazole, esomeprazole and omeprazole.Selection criteria: Studies were included if they were randomized control trials, case-control or cohort studies on human subjects.Case reports, review articles, opinion pieces and conference abstracts were excluded as well as studies with no or inappropriate control arms.Data collection and analysis: Only one eligible study was identified, so no analyses were able to be performed.Main results: There was only one clinical trial eligible for inclusion.This was a randomized clinical trial investigating the role of PPIs in the treatment of preterm preeclampsia in a high-risk, inpatient setting.This was a negative finding, with no change in the primary outcome of prolongation of gestation between the PPI group and placebo control.Conclusion: There is a scarcity of clinical trials published investigating the therapeutic potential of PPIs for preeclampsia and gestational hypertension.Of the one available study, PPIs were not found to pro-