Abstract
OBJECTIVE: To explore the effects of multivitamin combined with magnesium sulfate on placental hemodynamics, coagulation function, and maternal and infant outcomes in preeclampsia patients. METHODS: A randomized controlled study was conducted among 194 pregnant women diagnosed with preeclampsia between April 2022 and April 2023. Participants were randomly assigned to either the control group (n = 97), receiving intravenous magnesium sulfate alone, or the observation group (n = 97), receiving magnesium sulfate combined with multivitamin supplementation. Magnesium sulfate was administered with a loading dose of 2.5-5 g via rapid IV infusion and a maintenance dose of 5-20 g by continuous drip. The observation group additionally received one oral multivitamin tablet (Bayer S.A., 30 tablets/box) once daily in the morning. The treatment duration for both groups was two weeks. Blood pressure, 24-hour urinary protein, placental Doppler indices (RI, PI, S/D), coagulation markers (PT, APTT, FIB, TT), and maternal-infant outcomes were measured and compared. RESULTS: After treatment, both groups showed significant reductions in systolic and diastolic blood pressure, but there was no significant difference between them. However, the observation group had significantly lower 24-hour urinary protein levels (0.71 ± 0.31 g vs. 0.92 ± 0.28 g, P < 0.001). Coagulation function improved in both groups, with the observation group showing greater improvements: longer PT, APTT, and TT times, and lower FIB levels (P < 0.01). Placental hemodynamics also improved more in the observation group, with lower resistance indices and S/D ratios in both the umbilical and spiral arteries (P < 0.001). The observation group had better maternal and neonatal outcomes, including fewer cases of postpartum hemorrhage (10 vs. 22, P = 0.020), low birth weight (10 vs. 23, P = 0.013), and NICU admissions (9 vs. 21, P = 0.018). Eclampsia occurred only in the control group (3 cases), though this was not statistically significant (P = 0.081). Other outcomes, such as uterine inertia and neonatal asphyxia, were similar between groups. Subgroup analysis showed that patients with severe preeclampsia in the observation group experienced greater improvements in proteinuria and placental blood flow than those in the control group. Cesarean section rates were comparable (58 vs. 62), with main indications including fetal distress, failed labor, and poorly controlled PE. Logistic regression confirmed that multivitamin use was an independent factor for better outcomes (OR = 3.297; 95% CI: 1.731-6.282; P < 0.001), regardless of age, BMI, or gestational age. CONCLUSION: Multivitamin supplementation combined with magnesium sulfate improves outcomes in preeclampsia more effectively than magnesium sulfate alone. It reduces proteinuria, enhances placental blood flow and coagulation function, and lowers the risk of complications such as postpartum hemorrhage, low birth weight, and NICU admission. These benefits are particularly notable in severe cases and are independent of baseline maternal factors, supporting the use of combined therapy in clinical practice.