akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347/ob.gyn.rep.2026.739akusherstvo-2784Research ArticleREVIEW ARTICLEНАУЧНЫЙ ОБЗОРUse of low molecular weight heparins for the preventing placenta-associated complications: a systematic review and meta-analysisПрименение низкомолекулярных гепаринов для профилактики плацента-ассоциированных осложнений: систематический обзор и метаанализhttps://orcid.org/0000-0002-2783-3032КапустинР. В.KapustinR. V.

Роман Викторович Капустин, д.м.н.

199034 Санкт-Петербург, Менделеевская линия, д. 3; 199034 Санкт-Петербург, Университетская набережная, д. 7/9

Roman V. Kapustin, MD, Dr Sci Med. 

3 Mendeleevskaya Line, Saint Petersburg 199034; 7/9 Universitetskaya Embankment, Saint Petersburg 199034

kapustin.roman@gmail.comКиселеваА. В.KiselevaA. V.

Александра Владимировна Киселева

199034 Санкт-Петербург, Университетская набережная, д. 7/9

Aleksandra V. Kiseleva

7/9 Universitetskaya Embankment, Saint Petersburg 199034

https://orcid.org/0000-0002-0642-7924АлексеенковаЕ. Н.AlekseenkovaE. N.

Елена Николаевна Алексеенкова, к.м.н.

199034 Санкт-Петербург, Менделеевская линия, д. 3

Elena N. Alekseenkova, MD, PhD. 

3 Mendeleevskaya Line, Saint Petersburg 199034

https://orcid.org/0000-0002-9328-8909КоптееваЕ. В.KopteevaE. V.

Екатерина Вадимовна Коптеева, к.м.н.

199034 Санкт-Петербург, Менделеевская линия, д. 3

Ekaterina V. Kopteeva, MD, PhD. 

3 Mendeleevskaya Line, Saint Petersburg 199034

https://orcid.org/0009-0003-5918-2697КорнюшинаЕ. А.KornyushinaE. A.

Екатерина Амировна Корнюшина, к.м.н.

199034 Санкт-Петербург, Менделеевская линия, д. 3

Ekaterina A. Kornyushina, MD, PhD. 

3 Mendeleevskaya Line, Saint Petersburg 199034

ФГБНУ «Научно-исследовательский институт акушерства, гинекологии и репродуктологии имени Д.О. Отта» Министерства здравоохранения Российской Федерации; ФГБОУ ВО «Санкт-Петербургский государственный университет»РоссияOtt Research Institute of Obstetrics, Gynecology, and Reproductive Medicine, Ministry of Health of the Russian Federation; Saint Petersburg State University, Ministry of Health of the Russian FederationRussian FederationФГБОУ ВО «Санкт-Петербургский государственный университет»РоссияSaint Petersburg State University, Ministry of Health of the Russian FederationRussian FederationФГБНУ «Научно-исследовательский институт акушерства, гинекологии и репродуктологии имени Д.О. Отта» Министерства здравоохранения Российской ФедерацииРоссияOtt Research Institute of Obstetrics, Gynecology, and Reproductive Medicine, Ministry of Health of the Russian FederationRussian Federation20202904202600Online First2784Copyright © Kapustin R.V., Kiseleva A.V., Alekseenkova E.N., Kopteeva E.V., Kornyushina E.A., 20202020Капустин Р.В., Киселева А.В., Алексеенкова Е.Н., Коптеева Е.В., Корнюшина Е.А.Kapustin R.V., Kiseleva A.V., Alekseenkova E.N., Kopteeva E.V., Kornyushina E.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/2784Aim

Aim: to evaluate the effectiveness of low-molecular-weight heparins (LMWHs) in preventing placenta-associated complications (РАС), such as preeclampsia (PE), fetal growth restriction (FGR), intrauterine fetal death (IUFD) and placental abruption (PА), in women at high risk for these complications but without thrombophilia or thromboembolic disorders, based on a review and meta-analysis of publications released within the last twenty years.

Materials and Methods

Materials and Methods. A search for relevant randomized controlled trials was conducted in electronic databases (PubMed/MEDLINE, Embase, Web of Science, etc.) spanning from 2005 to 2025. The meta-analysis included 11 trials involving a total of 1965 women. PE, FGR, IUFD, and PA were considered as the primary outcomesFixed-effects models were used for analysis, and the results were presented as risk ratios with 95 % confidence intervals.

Results

Results. LMWHs use was associated with a reduced IUFD risk (0.77 [0.65; 0.90]; p = 0.001), PA (0.67 [0.52; 0.86]; p = 0.002), and PE occurrence (0.74 [0.62; 0.89]; p = 0.001). No significant effect of LMWHs use on FGR risk was found (0.93 [0.69; 1.25]; p = 0.62). Considerable heterogeneity (I² > 60 %) was observed while analyzing IUFD, PE and PA. Funnel plot assessment did not rule out a potential risk of publication bias and requires further investigation.

Conclusion

Conclusion. Prophylactic LMWHs use in women at high risk for РАС without thrombophilia may reduce the incidence of complications such as PE, IUFD, and PA. These findings indicate the need for multicenter studies with detailed analyses to identify patient cohorts where prophylactic LMWHs use for complication prevention provides a clear clinical and pathogenetic rationale.

Цель

Цель: оценить эффективность применения низкомолекулярных гепаринов (НМГ) в профилактике плацента-ассоциированных осложнений (ПАО) – преэклампсии (ПЭ), задержки роста плода (ЗРП), внутриутробной гибели плода (ВГП) и отслойки плаценты (ОП) у женщин из группы высокого риска по развитию данных осложнений без тромбофилии и тромбоэмболических осложнений на основании систематического обзора и метаанализа публикаций последних 20 лет.

Материалы и методы

Материалы и методы. Поиск релевантных рандомизированных контролируемых исследований проводили в электронных базах данных (PubMed/MEDLINE, Embase, Web of Science и др.) за период с 2005 по 2025 гг. В метаанализ были включены 11 исследований с общим участием 1965 женщин. Первичными исходами были реализация ПЭ, ВГП, ОП и ЗРП. Для анализа использовали модели фиксированных эффектов, результаты представлены в виде относительного риска с 95 % доверительным интервалом.

Результаты

Результаты. Применение НМГ ассоциировано со снижением риска ВГП (0,77 [0,65; 0,90]; p = 0,001), ОП (0,67 [0,52; 0,86]; р = 0,002) и реализации ПЭ (0,74 [0,62; 0,89]; р = 0,001). Не выявлено значимого влияния применения НМГ на риск развития ЗРП (0,93; [0,69; 1,25]; р = 0,62). В анализах исходов ВГП, ПЭ и ОП наблюдалась значительная гетерогенность (I² > 60 %). Оценка воронкообразных графиков не позволяет исключить потенциальный риск публикационной предвзятости и требует дальнейшего изучения опроса.

Заключение

Заключение. Профилактическое применение НМГ у женщин с высоким риском ПАО без тромбофилии может снижать частоту таких осложнений как ПЭ, ВГП и ОП. Полученные результаты указывают на необходимость проведения многоцентровых исследований с последующим детальным анализом их результатов для определения целевой группы пациенток, для которых профилактическое применение НМГ с целью профилактики осложнений имеет клинико-патогенетическое обоснование.

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The authors declare that there are no conflicts of interest present.