Pharmacotherapy for preeclampsia in low and middle income countries: an analysis of essential medicines lists.

Abstract

OBJECTIVE:

To determine the prevalence of drugs for comprehensive management of preeclampsia in national essential medicine lists (EMLs) in low and middle income countries (LMICs)

METHODS:

We collected EMLs from the 144 LMICs identified by the World Bank through broad-based Internet searches and in collaboration with the World Health Organization. We identified therapies for hypertension, eclampsia, preeclampsia complications (e.g., pulmonary edema, thrombosis), preterm birth, and labour induction contained in the EMLs.

RESULTS:

In 91 EMLs obtained from 144 LMICs, the most commonly listed parenteral antihypertensive therapies were verapamil (63.7%), hydralazine (61.5%), sodium nitroprusside (48.3%), and propranolol (39.6%). The most prevalent oral antihypertensive therapies were nifedipine (95.6%), methyldopa (93.4%), propranolol (90.1%), and atenolol (87.9%). For eclampsia/preeclampsia, magnesium sulphate was present in 84.6% of EMLs and calcium gluconate in 85.7%. For pulmonary edema, most EMLs (94.5%) listed oral furosemide, for thrombosis 92.3% listed heparin, for acceleration of fetal pulmonary maturity 90.1% listed parenteral dexamethasone, and for labour induction 97.8% listed oxytocin or a prostanoid (usually misoprostol, 40.7%).

CONCLUSION:

EMLs of LMICs provide comprehensive coverage of preeclampsia pharmacotherapy. These EMLs may be used as advocacy tools to ensure the availability of these therapies within each country.

• Authors: Shifana Lalani, Tabassum Firoz, Laura A Magee, Diane Sawchuck, Beth Payne, Rebecca Gordon, Marianne Vidler, Peter von Dadelszen, Community Level Interventions for Pre-eclampsia (CLIP) Working Group
• Journal: Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC (J Obstet Gynaecol Can) Vol. 35 Issue 3 Pg. 215-223 (Mar 2013) ISSN: 1701-2163 [Print] Netherlands
• PMID: 23470109 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antihypertensive Agents
• Diuretics
• Fibrinolytic Agents
• Glucocorticoids
• Oxytocics
• Tocolytic Agents
• Oxytocin
• Magnesium Sulfate
• Dexamethasone
• Heparin
• Betamethasone

Topics

• Antihypertensive Agents (therapeutic use)
• Betamethasone (therapeutic use)
• Developing Countries
• Dexamethasone (therapeutic use)
• Diuretics (therapeutic use)
• Eclampsia (drug therapy)
• Female
• Fibrinolytic Agents (therapeutic use)
• Glucocorticoids (therapeutic use)
• Heparin (therapeutic use)
• Humans
• Magnesium Sulfate (therapeutic use)
• Oxytocics (therapeutic use)
• Oxytocin (therapeutic use)
• Pre-Eclampsia (drug therapy)
• Pregnancy
• Pulmonary Edema (drug therapy, etiology)
• Thromboembolism (drug therapy, etiology)
• Tocolytic Agents (therapeutic use)