sk reduction 0.09, 0.05 to 0.14). Supplementation with Larginine plus antioxidant vitamins need to be further evaluated in a low-risk population in order for the firm conclusion to be drawn.

3.6.6. Plasma Volume Expansion

Blood plasma volume increases gradually in women during the second half of pregnancy and is reduced in women with pre-eclampsia [54] . It is possible that women with pre-eclampsia might benefit from expanded plasma volume if it were to increase blood circulation for the mother and baby. However, the results of a systematic review [54] are inconclusive about the effects of plasma volume expansion for the treatment of women with pre-eclampsia.

3.6.7. Cigarette Smoking

Cigarette smoking adversely affects every organ system [55] . However, very strangely, smoking during pregnancy has been associated with a reduction in the risk of pre-eclampsia in [56] .

The relation between smoking and pre-eclampsia was studied in a review [56] , conducted from 1959 to March 2006 with a total of 48 epidemiological studies. Overall, smoking during pregnancy reduces the risk of pre-eclampsia by up to 50% with a dose-response pattern. This result was consistent with all nulliparous and multiparas women, singleton and multifetal pregnancies, and in all cases of mild and severe pre-eclampsia. However, the underlying mechanisms and the exact ingredients in cigarette smoke that influence the risk of pre-eclampsia is unclear. However, given the other harmful effects of smoking, this cannot be generally considered a prevention method for pre-eclampsia. Further research and more epidemiological studies are needed to enhance our understanding of the disease and to clarify this puzzling relationship.

3.6.8. Low-Dose Dopamine

The role of low-dose dopamine in the management of pregnant women with severe pre-eclampsia was assessed in a systematic review in [57] . Only one Randomized placebo-controlled trial of six hours’ duration, including 40 postpartum women, was found. However, it remained unclear whether low-dose dopamine therapy for pre-eclamptic women with oliguria is beneficial.

3.6.9. Progesterone

According to one theory the shortage of progesterone might be the cause of preeclampsia, hence it is believed that progesterone during pregnancy might help them to avoid pre-eclampsia. However, no reliable conclusions could be made about the effects of progesterone in preventing pre-eclampsia and its complications according to the result of a review in [58] .

3.6.10. Thiazide Diuretics

Diuretic drugs result in reducing the blood pressure by excreting more urine and hence relaxing blood vessels. Due to these effects, it has been believed that Diuretic drugs might lower the risk of pre-eclampsia in pregnant women. However, the result drew in a systematic review [59] (5 studies involving 1,836 women), showed insufficient evidence to draw reliable conclusions about the effects of diuretics on prevention of pre-eclampsia and its related complications. The risk of nausea and vomiting was also increased, therefore the use of diuretics for the prevention of pre-eclampsia and its related complications cannot be suggested.

3.6.11. Antioxidant Oral Lycopene

A randomized double-blind placebo-controlled trial [60] with 159 primigravidas (similar physical and social parameters) was conducted in India to evaluate the efficacy of antioxidant lycopene in preventing pre-eclampsia. 77 women received 2mg/day oral lycopene until delivery. There was no significant difference in developing pre-eclampsia. The results confirm that lycopene is not effective in preventing pre-eclampsia in healthy primigravidas. Rather, they result in the incidence of the adverse effects of preterm labor and low birth weight babies.

4. Conclusions

There are many medications and techniques that have been identified and assessed for its role in the prevention of pre-eclampsia and eclampsia. Magnesium sulfate so far has shown a great success in this regard and can be called as treatment of choice. It is more effective than diazepam, phenytoin, aspirin, calcium supplementation or lytic cocktail. However, despite the strong evidence, trials comparing alternative techniques are too small for reliable conclusions. There is insufficient evidence to show what the best dose and route of magnesium sulfate for women with pre-eclampsia or eclampsia are.

Similarly, the role of aspirin, calcium supplementation, and L-arginine plus antioxidant vitamins continues to be controversial. Its benefits and effectiveness range from small to moderate depending on the outcome. Further research is needed to assess which women are most likely to benefit. There is also insufficient evidence about whether to recommend rest or increased physical activity to women during pregnancy. Further research is highly desirable in different settings to explain its role in the development and prevention of pre-eclampsia and its complications.

There is evidence in the light of the included studies in this review as well as previous studies that supplementation with vitamins C and E did not reduce the risk of pre-eclampsia in both nulliparous and multiparous women. However, further research is needed to analyze the possibility that vitamin supplementation might be helpful in women with a low antioxidant status.

Another puzzling evidence we obtained from this review is that smoking during pregnancy reduces the risk of pre-eclampsia by up to 50% with a dose response pattern. This result was consistently found in nulliparous and multiparas, singleton and multifetal pregnancies for both mild and severe preeclampsia. Current literature does not give us a clear explanation for this supportive effect of smoking in pregnant women. However, considering its harmful effects, smoking cannot be considered as a prevention method for pre-eclampsia. Further research and more epidemiological studies are needed to enhance our understanding of the disease and to clarify this puzzling relationship.

Moreover, there are no systematic reviews and control trails based on immediate delivery of the baby (the definitive treatment for pre-eclampsia and eclampsia) and another important standard-of-care treatment (non-diuretic anti-hypertensives).

We also recommend further research into assessing the role and importance of current and new technologies and techniques in the reduction of pre-eclampsia and eclampsia. All nurses or midwives should know the evidence about the prevention and treatment of pre-eclampsia and eclampsia to identify the nursing care that is essential to guide the pregnant woman and family and prevent adverse events related to the use of preferred techniques and medications.

Acknowledgements

We wish to thank The World Academy of Sciences (TWAS), Italy and the National Council for Scientific and Technological Development (CNPq), Brazil for their financial assistance.

Conflicts of Interest

The authors declare no conflicts of interest.

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