Pharmacological Interventions for the Prevention of Fetal Growth Restriction: A Systematic Review and Network Meta‐Analysis

The prevention of fetal growth restriction (FGR) is challenging in clinical practice. To date, no meta‐analysis summarized evidence on the relative benefits and harms pharmacological interventions for FGR prevention. We performed a systematic review network (NetMA), searching PubMed, Embase, Cochrane Library, ClinicalTrials.gov from inception until November 2019. included trials observational studies singleton gestating women evaluating antiplatelet, anticoagulant, or other treatments, compared between each with controls (placebo treatment), considering pregnancy outcome (primary NetMA). Secondary efficacy outcomes preterm birth, placental abruption, neonatal death. Safety bleeding thrombocytopenia. Network meta‐analyses using frequentist framework were conducted to derive odds ratios (ORs) 95% confidence intervals (CIs). Of 18,780 citations, we 30 4,326 patients. Low molecular weight heparin (LMWH), alone associated low‐dose aspirin (LDA), appeared more efficacious than preventing (OR 2.00, CI 1.27–3.16 OR 2.67, 1.21–5.89 vs. LMWH LDA + LMWH, respectively). No difference active treatments emerged terms prevention, but estimates +/‐ imprecise. Only regarding was judged as moderate, according Confidence Meta‐Analysis framework. treatment an increased risk bleeding, although precise enough only LMWH. These results should inform clinicians prophylaxis