Lower incidence of vascular complications during pregnancy in women treated with low dose aspirin in in-vitro-fertilisation (IVF)

Abstract

OBJECTIVE: The basis of (late) vascular complications in pregnancy, such as high blood pressure and pre-eclampsia, is known to be founded in early stages of pregnancy. The process of placentation plays a role in development of high blood pressure or pre-eclampsia later in pregnancy. As an inhibitor of the cyclo-oxygenase (COX) enzyme aspirin inhibits thromboxane A2 and reduces vasoconstriction. The use of low-dose aspirin early in pregnancy may therefore influence the process of placentation and potentially the chance of developing complications later in pregnancy.DESIGN: Follow-up in a prospective randomised controlled trial.MATERIALS AND METHODS: Fifty-four patients had an ongoing pregnancy in a prospective randomised double blind placebo controlled trial investigating the effect of low-dose aspirin on pregnancy rates among IVF/ICSI patients with previous implantation failure. None of these patients had a history of high blood pressure. All patients had used 100 mg of aspirin or 100 mg placebo daily during a long GnRH-agonist protocol and had continued the study medication until 12 weeks of pregnancy. After delivery all patients received a questionnaire inquiring after complications during pregnancy, delivery and after the health their babies. These data were linked with the data of their hospital records, that where checked for complications during pregnancy, delivery and the health the baby.RESULTS: All 54 patients received a questionnaire, 28 patients were treated with aspirin (group A) and 26 patients with placebo (group B). Four women in group A and nine women in group B had a twin pregnancy. The overall response rate was 85%. In group A twelve women had no complications during pregnancy, one woman had a high blood pressure during pregnancy and 4 women reported blood loss during pregnancy. In group B six women had no complications during pregnancy, 5 women had a high blood pressure, 2 women had a high blood pressure with pre-eclampsia, of which one developed a HELLP-syndrome, one woman had a pulmonary embolism and 4 women reported blood loss during pregnancy. The incidence of vascular complications during pregnancy was significantly higher in group B: 3.6% vs 26.9%, p<0.05. Other outcome was not different between the groups.CONCLUSIONS: Women treated with low dose aspirin during IVF treatment and the first 12 weeks of their pregnancy had significantly lower incidence of blood pressure related complications during pregnancy. OBJECTIVE: The basis of (late) vascular complications in pregnancy, such as high blood pressure and pre-eclampsia, is known to be founded in early stages of pregnancy. The process of placentation plays a role in development of high blood pressure or pre-eclampsia later in pregnancy. As an inhibitor of the cyclo-oxygenase (COX) enzyme aspirin inhibits thromboxane A2 and reduces vasoconstriction. The use of low-dose aspirin early in pregnancy may therefore influence the process of placentation and potentially the chance of developing complications later in pregnancy. DESIGN: Follow-up in a prospective randomised controlled trial. MATERIALS AND METHODS: Fifty-four patients had an ongoing pregnancy in a prospective randomised double blind placebo controlled trial investigating the effect of low-dose aspirin on pregnancy rates among IVF/ICSI patients with previous implantation failure. None of these patients had a history of high blood pressure. All patients had used 100 mg of aspirin or 100 mg placebo daily during a long GnRH-agonist protocol and had continued the study medication until 12 weeks of pregnancy. After delivery all patients received a questionnaire inquiring after complications during pregnancy, delivery and after the health their babies. These data were linked with the data of their hospital records, that where checked for complications during pregnancy, delivery and the health the baby. RESULTS: All 54 patients received a questionnaire, 28 patients were treated with aspirin (group A) and 26 patients with placebo (group B). Four women in group A and nine women in group B had a twin pregnancy. The overall response rate was 85%. In group A twelve women had no complications during pregnancy, one woman had a high blood pressure during pregnancy and 4 women reported blood loss during pregnancy. In group B six women had no complications during pregnancy, 5 women had a high blood pressure, 2 women had a high blood pressure with pre-eclampsia, of which one developed a HELLP-syndrome, one woman had a pulmonary embolism and 4 women reported blood loss during pregnancy. The incidence of vascular complications during pregnancy was significantly higher in group B: 3.6% vs 26.9%, p<0.05. Other outcome was not different between the groups. CONCLUSIONS: Women treated with low dose aspirin during IVF treatment and the first 12 weeks of their pregnancy had significantly lower incidence of blood pressure related complications during pregnancy.