Calcio-ácido linoleico en la prevención de la preeclampsia y la hipertensión arterial inducida por el embarazo

Abstract

En 12 centros de salud de Cali, se hizo un ensayo clínico controlado, al azar, que incluyó 91 gestantes primigrávidas, normotensas, con alto riesgo biopsicosocial, una prueba de presión arterial supina positiva y una presión arterial media alta. Las futuras madres se asignaron a 3 grupos: 43 (47.2%) al grupo de intervención (Grupo A: calcio elemental, 600 mg, ácido linoleico, 450 mg); y 48 (52.7%) a 2 grupos controles [Grupo B: 24 (26.3%), con intervención psicosocial y placebo; Grupo C: otras 24 (26.3%) que recibieron doble placebo.] Para comenzar el estudio se hizo una evaluación obstétrica y nutricional, con evaluación prospectiva del resultado perinatal. La edad promedio fue 21.1±4.9 años; no hubo diferencias estadísticas en las variables sociodemográficas. Del total, 20 (21.9%) pacientes desarrollaron HIEP; en el Grupo A, 4 (9.3%) [RR = 0.22 (i.c. 95% 0.08 - 0.64), p = 0.001]; en el Grupo control B, 4 (16.7%); y en el Grupo control C, 12 (50.0%). El calcio elemental y el ácido linoleico en dosis bajas, durante el tercer trimestre del embarazo, disminuyeron significativamente la incidencia de preeclampsia en pacientes con alto riesgo de desarrollarla. We carried out a prospective, randomized, double-blind, placebocontrolled study to investigate the capacity of linoleic acid/calcium and psychosocial support to prevent pregnancy-induced hypertension and pre-eclampsia. A total of 1,676 healthy primigravid women were screened with use of the prenatal biopsychosocial risk score, the roll-over test (a comparison of blood pressure before and after the woman rolls from her left side to her back) and the mean blood pressure during week 28 of 30 of gestation. Of 94 primigravid women with abnormal results [high biopsychosocial risk score (>3 pts), and increase in blood pressure during the roll-over test (> 15 mm Hg), and high mean blood pressure (>85 mm Hg)], 91 entered the study and were treated with a daily dose of either linoleic acid/calcium (Group A: 450/600 mg; 43 women) or placebo (Group B: psychosocial support and placebo; 24 women, Group C: placebo, 24 women) during the third trimester of pregnancy. The number of women in whom preeclamptic toxemia developed was significantly lower among the linoleic acid/calcium-treated than among the placebo-treated women [Group A: 4 (9.2%) vs. Group B: 4 (16.7%) vs. Group C: 12 (50%); p - 0.001] and reduced the relative risk to 0.22 (ci 95% 0.08-0.64, chi2 = 9.62, p = 0.03]. We conclude that low daily doses of linoleic acid/calcium taken during the third trimester of pregnancy significantly reduce the incidence of preeclamptic toxemia in women at high risk for this disorder.