Preeclampsia In High-risk Pregnant Women Research Articles

The optimal dosage of aspirin for preventing preeclampsia in high-risk pregnant women: A network meta-analysis of 23 randomized controlled trials.

This study aimed to assess the effectiveness and optimal dosage of aspirin in preventing preeclampsia in high-risk pregnant women. Traditional and network meta-analyses were conducted on data from 23 randomized controlled trials involving 10547 pregnant women. The findings demonstrated that aspirin significantly reduced the incidence of preeclampsia (OR=0.66, 95%CI [0.58, 0.75]), with the best preventive effect observed at a dosage of 80-100mg/day (OR=0.51, 95%CI [0.36, 0.72]). No significant differences were found in the occurrence of postpartum hemorrhage (OR=1.03, 95%CI [0.79, 1.33]), small for gestational age (OR=0.83, 95%CI [0.50, 1.35]), placental abruption (OR=0.96, 95%CI [0.53, 1.73]), and intrauterine growth restriction (OR=0.63, 95%CI [0.45, 1.86]) between women taking aspirin and those taking placebos. Different doses of aspirin showed a reduction in preeclampsia incidence, but there was no significant difference in efficacy between the dosage groups. Side effects did not significantly differ between placebo and different aspirin dosage groups. SUCRA analysis suggested that 80-100mg/day may be the optimal dosage, prioritizing both effectiveness and minimizing side effects. Sensitivity analysis confirmed the robustness of the findings. However, improvements are needed in addressing issues like loss to follow-up, reporting bias, and publication bias. In conclusion, a dosage of 80-100mg/day is recommended for preventing preeclampsia in high-risk pregnant women, although individual circumstances should be considered for optimizing the balance between effectiveness and safety.

Can placental shear wave elastography predict preeclampsia in high-risk pregnant women during second trimester? Insights from a prospective cohort study

BackgroundPreeclampsia, a condition very frequently linked to maternal and fetal deaths worldwide, remains a pressing concern due to delays in recognition and response. Effective screening tests for early detection of high-risk cases and appropriate preventive measures are currently lacking. Well planned prenatal care, timely detection, monitoring, and appropriate management are vital to prevent preeclampsia-related fatalities.MethodsThis prospective study evaluated the use of shear wave elastography (SWE) in identifying placental structural issues caused by preeclampsia in high-risk pregnancies. A total of 143 high-risk pregnant women with singleton pregnancies and an anterior placental position were included in the study.ResultsWomen with preeclampsia exhibited significantly elevated SWE values in both center (27.98 ± 16.12 vs. 4.57 ± 6.57 kPa) and peripheral areas of the placenta (29.14 ± 16.12 vs. 4.80 ± 7.70 kPa) when compared to non-preeclampsia women (p = 0.000). Cutoff values of 8.70 kPa and 8.15 kPa at the Center and edge of the placenta respectively, accurately predicted preeclampsia in second-trimester pregnancies, with 84.62% sensitivity and 94% specificity. However no significant difference was observed between elastography values obtained from the center and edge of the placenta.ConclusionsIn conclusion, shear wave elastography can help diagnose preeclampsia early by assessing placental stiffness.

Aspirin administration from early pregnancy versus initiation after 11 weeks of gestation for prevention of pre-eclampsia in high-risk pregnant women: Study protocol for randomized controlled trial.

Pre-eclampsia (PE) is a multiorgan disorder that affects 2-5% of all pregnant women. Present recommendations for when to start aspirin in high-risk women are after 11 wk of gestation. We present a protocol to investigate the effectiveness of aspirin use from early pregnancy, which is a randomized controlled trial to assess whether prescribed low-dose aspirin from early pregnancy reduces the prevalence of early and late-onset PE. Additionally, to compare the effectiveness of aspirin administration before and after 11 wk in reducing the occurrence of PE? All pregnancies at risk of PE, according to demographic and midwifery history, who are referred to the Maternal-Fetal Clinic of Tehran University hospital, Tehran, Iran were invited to take part in the trial. The outcomes of pregnancy and newborns will be gathered and analyzed. The first registration for the pilot study was in January 2023, and the participants were recognized as high-risk for PE. In addition, enrollment in the main study will begin as of October 2023.

Platelet Parameters in Nonthrombocytopenic Preeclampsia: A Case-Control Study

الخلاصة
 الخلفية: مقدمات الارتعاج هو اضطراب خاص بالحمل متعدد الأجهزة، يتميز بتطور ارتفاع ضغط الدم والبيلة البروتينية التي تنشأ بعد الأسبوع العشرين من الحمل في امرأة كانت ذات ضغط طبيعي سابقًا ويرتبط الحمل بالتكيف الفسيولوجي الذي يؤدي الى تغيير في نظام الدم ومن ضمنها معلمات الصفائح الدموية.
 هدف الدراسة: دراسة لمقارنة العلاقة بين عدد الصفائح الدموية (pc) ومؤشرات الصفائح الدموية وهي متوسط حجم الصفائح الدموية (MPV) وتوزيع الصفائح الدموية (PDW) ونسبة عدد الصفائح الى حجمها في النساء المصابات بمقدمات الارتعاج مع النساء ذوات الحمل الطبيعي.
 المرضى والطريقة: تم إجراء دراسة الحالة والشاهد في قسم النسائية والتوليد في مستشفى الخنساء التعليمي للأطفال والولادة ، الموصل، العراق على مدى فترة تمتد من الاول من شباط ٢٠٢٠ إلى نهاية كانون الأول٢٠٢٠. شاركت عينة من ١٢٠ امرأة حامل في الدراسة ممن استوفين معايير الاشتمال. ٦٠ منهن تم تشخيص إصابتهن بمقدمات الارتعاج (٣٠ امرأة حامل مع مقدمة الارتعاج الخفيف و ٣٠ امرأة حامل مع مقدمة الارتعاج الشديد و٦٠ امرأة حامل حملا طبيعيا كمجموعة شاهد. تم قياس عدد الصفائح الدموية ومتوسط حجم الصفائح الدموية كجزء من تعداد الدم الكامل.
 النتائج: علاقة خطية معنوية بين متوسط حجم الصفائح الدموية (MPV) وعرض توزيع الصفائح الدموية (PDW) بمتوسط ضغط شرياني في مجموعة تسمم الحمل بقيمة p (0.025 و 0.001) على التوالي وعلاقة عكسية معنوية بين عدد الصفائح الدموية ومتوسط الضغط الشرياني مع p تمت ملاحظة قيمة (<0.001).
 الخلاصة: تعتبر مؤشرات الصفائح الدموية فعالة من حيث التكلفة، وسهلة القياس، وعلامات عملية لرصد مقدمة الارتعاج ، وان متوسط حجم الصفائح الدموية وعرض توزيعها له علاقة طردية كبيرة مع متوسط الضغط الشرياني في حالة مقدمة الارتعاج الشديد.
 الكلمات المفتاحية: مقدمة الاتعاج, معلمات الصفائح الدمويه, عدد الصفائح الدمويه, حجم الصفائح الدمويه, توزيع الصفائح الدمويه.

Abstract P201: First Trimester Anxiety Is Associated With Increased Arterial Stiffness In High-risk Pregnant Women

Preeclampsia is a leading pregnancy complication characterized by vascular dysfunction, leading to hypertension and organ damage. Evidence suggests positive associations between higher arterial stiffness and preeclampsia, as well as anxiety and preeclampsia. Anxiety, a transdiagnostic factor, is also associated with increased arterial stiffness in the general population, but no reports exist in pregnant women. Moreover, the association between anxiety and arterial stiffness in pregnancy and the risk of developing preeclampsia has not yet been explored. To address this gap, we aimed to evaluate the role of anxiety in arterial stiffness measurements and the development of preeclampsia in high-risk pregnant women. In this prospective study, women with high-risk singleton pregnancies before 14 weeks gestation were recruited at two tertiary care obstetric clinics in Montreal, Canada, and followed throughout pregnancy. Arterial stiffness parameters (carotid-femoral pulse wave velocity [cfPWV]) were measured at baseline (10-13 weeks gestation) and at four-week intervals throughout pregnancy. Self-reported anxiety symptoms were recorded using the Beck Anxiety Inventory, and participants’ scores were ranked as having minimal, mild, moderate, or severe anxiety. After excluding incomplete questionnaires, the total study sample comprised 156 women, of whom 10 (6.4%) developed preeclampsia. There was no difference in anxiety scores between groups based on baseline characteristics (i.e., age, BMI, and race). First trimester anxiety scores were associated with increased cfPWV in the early and late second trimester time points (p=0.02, p= 0.04, respectively). Higher baseline anxiety was also associated with a greater increase in cfPWV from baseline to 18 weeks gestation (p=0.04). A trend was also observed between baseline anxiety scores and the development of preeclampsia (p=0.07). Anxiety in the first trimester of pregnancy is associated with higher cfPWV values and a greater increase from the first to the second trimester, as well as potentially a higher risk for preeclampsia. Our ongoing study will further explore these findings as they can have important implications for patient prenatal care.

Clinical efficacy of low-dose aspirin combined with calcium in preventing preeclampsia: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to evaluate the clinical effectiveness of low-dose aspirin combined with calcium supplements for the prevention of preeclampsia. China National Knowledge Infrastructure, VIP, Wanfang, PubMed, EMBASE, and Cochrane Library databases were searched from inception until December 2022. Randomized controlled trials investigating the preventive use of aspirin in combination with calcium supplementation for preeclampsia in high-risk pregnant women were included. The quality of the literature was evaluated, and a meta-analysis was conducted using RevMan 5.3 software to analyze the clinical efficacy of low-dose aspirin combined with calcium supplementation in preventing preeclampsia. Seven randomized controlled trials were included in this meta-analysis, and compared with the control group, the experimental group had lower incidence rates of preeclampsia with gestational hypertension (odds ratios [OR]: 0.17, 95% confidence interval [CI]: 0.11-0.28), preeclampsia (OR: 0.20, 95% CI: 0.10-0.37), gestational hypertension (OR: 0.15, 95% CI: 0.07-0.31), preterm birth (OR: 0.26, 95% CI: 0.16-0.44), postpartum hemorrhage (OR: 0.15, 95% CI: 0.08-0.27), and fetal growth restriction (OR: 0.16, 95% CI: 0.08-0.33). Compared with aspirin alone, low-dose aspirin combined with calcium supplementation was more effective in preventing preeclampsia, reduced the risk of preterm birth and postpartum hemorrhage, and promoted fetal growth. This intervention has clinical value and should be considered for high-risk pregnant women.

A Randomized Controlled Study Comparing the Efficacy of 75mg Versus 150mg Aspirin for the Prevention of Preeclampsia in High-Risk Pregnant Women.

Background Preeclampsia is a major factor in both maternal and fetal morbidity and mortality. The most widely investigated preeclampsia prevention medication is low dose Aspirin. However, guidelines differ considerably regarding the prophylactic dose of Aspirin for preeclampsia. Objective The objective is to compare the efficacy of 150mg versus 75mg Aspirin for the prevention of preeclampsia in pregnant women at high risk of preeclampsia. Methodology This was a parallel, open-label, randomized control trial carried over a period of one year and three months at a tertiary care center ofEasternIndia. Block randomization was done and block sizes of 2 and 4 were used to ensure balanced distributions within the study arms. Primary outcome was the development of preeclampsia and secondary outcomes were fetomaternal complications in both groups. Results The present clinical trial was conducted on 116 pregnant women with a risk factor of preeclampsia andthey were randomly assigned to receive either 150mg or 75mg of Aspirin daily beginning from 12 to 16 weeks of gestation till 36 weeks' gestation. A significantly greater number of pregnant females who received Aspirin 75mg (33.92%) developed preeclampsia in contrast to those who received Aspirin 150mg (8.77%), p=0.001, OR = 5.341, 95%CI = 1.829-15.594. There was an insignificant difference in fetomaternaloutcome among both the groups ofwomen. Conclusion Among womenwho are at high risk of developing preeclampsia, Aspirin 150 mg once a day at bedtime is more effective than Aspirin 75 mg once a day at bedtime in preventing preeclampsia with similar fetomaternal outcomes (NICU admission, IUGR, neonatal death, still birth, eclampsia, HELLP syndrome, placental abruption and pulmonary edema).

Frequency of Pre-Eclampsia in High-Risk Pregnant Women Treated with Low Dose Aspirin (LDA) Presenting in Tertiary Care Hospital

Objective: To determine the frequency of pre-eclampsia among high-risk pregnant women treated with low dose aspirin (LDA) presenting in a tertiary care hospital. Study design: Descriptive study Duration of study: Six months from 20-02-2018 to 19-08-2018. Setting: Study was conducted in OPD of Obstetrics and Gynaecology Department, Combined Military Hospital, Lahore National University of Medical Sciences NUMS Material and methods: A total of 175 patients were included in the study. Pregnant females diagnosed as high risk were treated with low dose aspirin (75 mg) daily started at 12 to 16 weeks of gestation till the end of pregnancy. 24 hours urine protein test was done for patients with B.P. >140/90mmHg after 20 weeks of gestation and if at least 300mg protein was present in 24 hours urine then patient was labeled as pre-eclamptic. Results: Patients ranged between 20-35 years of age with mean age of 25.9±3.6 years. Mean gestational age was 14.4±1.1 weeks and mean BMI was 27.3±4.3 kg/m2. Pre-eclampsia developed in 27 patients (15.4%). Obesity found in 53 patients (30.3%). There were 27 (15.4%) primigravida and 148 (84.6%) multigravida patients. Conclusion: In conclusion, low dose aspirin is effective in prevention of preeclampsia in high-risk patients. Indications for aspirin in primary prevention are a matter of debate, but recent publications suggest a strategy based on first-trimester screening of preeclampsia (with clinical parameters, biomarkers and uterine artery Doppler measurements) and aspirin administration to high-risk patients. Keywords: Aspirin, High risk pregnancy, Pre-eclampsia

Prediction and prevention of preeclampsia by physicians in Brazil: An original study.

Considering the worldwide importance of preeclampsia, especially in Brazil, the screening of pregnant women at greater risk of developing the disease and the application of preventive measures are essential. This study aimed to assess the medical performance in this context in Brazil. A survey was developed to quantify the number of physicians who prescribe acetylsalicylic acid (ASA) and/or calcium for preeclampsia prevention. The survey was sent to all Brazilian obstetricians affiliated to the Brazilian Federation of OBGYN by email and WhatsApp. The survey remained opened for 6 months and included questions about the use of ASA and calcium, as well as about the use of a complementary test to predict preeclampsia. The sample consisted of 360 responding physicians and 100% coverage of responses from physicians from the five different regions of Brazil was obtained. The vast majority of respondents (94.72%) prescribe ASA to prevent preeclampsia, with 80.3% prescribing a dose of 100 mg/day. Calcium is prescribed by 83.9% of the respondents. The majority of the interviewed sample (58.6%) requests uterine artery Doppler imaging to predict preeclampsia and 31.7% do not request any additional test. When the analysis was performed by region, only the northern region differed from the other Brazilian regions regarding the use of ASA and calcium for preeclampsia prevention. While more than 90% of physicians in the other regions prescribe ASA, 40% in the northern region do not use it (p < 0.0001). Regarding calcium, 30% of physicians in northern Brazil do not use the drug for preeclampsia prevention, a percentage that also differs from the other regions where the medication is prescribed by 80 to 90% of physicians (p = 0.021). The vast majority of Brazilian physicians prescribe low-dose aspirin and calcium carbonate to prevent preeclampsia in high-risk pregnant women. In addition to the identification of clinical risk factors, most doctors use Doppler of the uterine arteries as a predictive method. In the northern region of Brazil, physicians use aspirin and calcium less frequently for preventing preeclampsia compared to the rest of the country.

Use of Prophylactic Aspirin in patients with previous history of Pre-eclampsia

Background: Aspirin is considered a safe and secure prophylactic or preventative agent for the treatment of preeclampsia patients. Pre- eclampsia is developed in pregnant women which cause complications in their pregnancy due to high blood pressure and damage to other body organs. The incidence of Pre-eclampsia is 2-8% of pregnancies, but has a higher risk of about 10% in those females suffering from hypertension or autoimmune diseases. Aim: To know how effectively aspirin is used in preventing the pre-eclampsia in pregnant women who have had the previous history of preeclampsia. Methodology: A randomized controlled trial of aspirin and placebo was conducted. The women enrolled in this study have a gestational period of 6 to 32 weeks. All the women were administrated with 80 mg of placebo or aspirin daily. All the continuous and categorial variables were analyzed statistically and the results were presented as mean±S.D. and frequency(%) for these variables, respectively. Results: All the data was gathered from 260 women who were enrolled in this study. It showed that the occurrence of pre-eclampsia was higher in the placebo group as compared to aspirin group (4.1% vs. 1.6%, p=0004). However, in every risk group, the effects of placebo and aspirin were the same for women with hypertension, the incidence was 13.4% in aspirin and 15.7% in placebo and for women with diabetes, the incidence was 6.7% in aspirin and 6.6% in placebo; but for women with previous history of pre-eclampsia, the incidence was 1.6% in aspirin and 4.1% in placebo which was significantly different. Further, the incidence of pre-eclampsia with primary and secondary outcomes in aspirin and placebo were the same. Conclusion: Our research finding reveals that a low dose of aspirin had a considerable therapeutic effect in preventing pre-eclampsia in high-risk pregnant women. Keywords: Pre-eclampsia, aspirin, preventive agent

Urinary Nephrin and Podocalyxin Levels as Predictors of Pre-eclampsia in High-Risk Pregnant Women.

Pre-eclampsia (PE) is characterized by new-onset hypertension and proteinuria. Damage of podocyte cells has been reported in pre-eclamptic women, thus podocyte specific proteins such as nephrin and podocalyxin could be useful biomarkers in PE. To investigate the role of urinary nephrin (u-nephrin) and urinary podocalyxin (u-PDX) levels in predicting PE in women with a high-risk pregnancy. We included 101 pregnant women in this study and allocated them into three groups: group 1 included pregnant women at high risk of developing PE (n=41), group 2 - pregnant women with PE (n=30), and group 3 was the controls including healthy pregnant women (n=30). The inclusion criteria for women with PE were de novo hypertension >140/90 mm Hg, proteinuria >300 mg/24 hours, and presence of edema after 20 weeks of gestation, while the exclusion criteria were a history of renal diseases and pregnant women younger than 18. Inclusion criteria for the group of women with a high-risk pregnancy was gestational week >15, a history of PE in a previous pregnancy, pre-existing diabetes type 1 or 2, pre-existing hypertension, multiple gestations, prior placental abruption, obesity women, nulliparity, maternal age >35 years, and a family history of PE. The study was conducted from March 2016 to May 2017 in the Medical Faculty at the Institute of Medical and Experimental Biochemistry in Skopje. Urine samples were used to measure the nephrin and podocalyxin levels using immunoenzyme assay, creatinine and microalbumin. Blood samples were collected for biochemical analyses. U-nephrin levels were elevated in 96.7% of women with PE, and 73% of women with a high-risk pregnancy. U-PDX levels were elevated in 63% of the women with PE and 100% of the women with a high-risk pregnancy. U-nephrin and u-PDX levels were significantly increased in women with a high-risk pregnancy and women with PE compared with a control group (p.

SUPLEMENTASI DOCOSAHEXAENOIC ACID (DHA) SEBAGAI USAHA PREVENTIF IBU HAMIL DENGAN RISIKO PREEKLAMPSIA

Hypertension in pregnancy is one of the main cause of maternal death in the world. Hypertensive disorders in pregnancy, including preeclampsia, have a broad spectrum of conditions associated with maternal and fetal morbidity and mortality. Preeclampsia is a syndrome characterized by new onset of hypertension at ≥20 weeks of gestation, in pregnant women who were previously normotensive and accompanied by proteinuria. This paper aims to determine the effectiveness of docosahexaenoic acid (DHA) in pregnant women to prevent the risk of preeclampsia. This research method is to review the articles published in the last 10 years with the keywords preeclampsia, therapy, preventive, and docosahexaenoic acid (DHA). The data show that administration of docosahexaenoic acid (DHA) can reduce the risk of preeclampsia with minimal side effects for both maternal and the fetus. DHA on the other hand is still insignificant in preventing preeclampsia in high-risk pregnant women and prescribing the high dose of DHA is not recommended for pregnant women. DHA will be more effective in preventing preeclampsia if given in early pregnancy, especially in the first trimester of pregnancy

Application of the Electronic Nose in Predicting Preeclampsia in High-risk Pregnancies. Pilot Study

Preeclampsia is a syndrome that affects 2-8 % of pregnancies worldwide and is the leading cause of maternal death. Therefore, early detection is crucial to identify women who require clinical monitoring during pregnancy and to evaluate new preventive therapies before clinical symptoms occur. The chemical fingerprints of the urine from three study groups pregnant with Preeclampsia, Healthy Pregnant (HP) and pregnant at High Risk of Preeclampsia (HRP) were evaluated using an electronic nose and the data obtained were subjected to principal component analysis (PCA), Canonical Analysis of Principal Coordinates (CAP), Partial Least Squares - Discriminant Analysis (PLS-DA) and ROC curves to determine the diagnostic power of the test. A separation was found between the patients with preeclampsia and HP explaining 99% of the variability of the data. Subsequently, a CAP was obtained with a correct classification of 100%, and the PLS-DA was obtained an accuracy of 88%. With the results of axis CAP1, a ROC curve was performed resulting in a sensitivity of 100% and a specificity of 95.5%. Based on the CAP model it was found that 36% (n=9) of the HRP patients would develop preeclampsia based on the metabolites found in urine. metabolomics can be used as a tool for early detection of preeclampsia in high-risk pregnant women, using portable olfactory technology.

Новые возможности для профилактики преэклампсии

The analysis of literature data on the role of placenta disorders in the development of preeclampsia (PE) was performed according to Pubmed and eLibrary updates. Although a complete understanding of the pathogenesis of PE remains unclear, the placenta theory was found as one of the principal ones. The appropriateness of prescribing progestogens for the prevention of PE is the subject of an actual debate. Based on the results of our own research, there was demonstrated the efficacy in the preventative prescription of dydrogesterone (at a dose of 30 mg/day) from early periods to 20 weeks of gestation in pregnant women with high-risk factors. The rescription of dydrogesterone contributed to a statistically significant reduction in this pregnancy complication (13.1 and 71/4%, p &lt; 0,001).It was found that women taking dydrogesterone significantly less developed such disorders as arterial hypertension (3.2 and 71.2%, p &lt; 0.001), proteinuria (0 and 66.18%, p &lt; 0.001), fetal growth restriction (2.2 and 21.58%, p &lt; 0.001), uteroplacental vascular insufficiency (3.2 and 21.58%, p &lt; 0.001), and preterm birth (8.6 and 53.95%, p &lt; 0.001). Conclusion. The importance of the placental factor in the pathogenesis of PE, the prescription of progestogens corresponds to the main principle of pathogenetic prevention of this complication. Administration of dydrogesterone in the first and second trimesters (6 to 20 weeks of pregnancy) significantly reduces the incidence of PE in high-risk pregnant women. Key words: preeclampsia, prevention, high-risk groups, progestogens, dydrogesterone

Preconception preparation for pregnancy

Background. Experience in high-risk obstetrics shows that a significant part of the determining factors affects the woman and the fetus before the first visit to the doctor. Improving a woman’s health before conception can improve her reproductive performance and reduce financial costs spent on obstetric medical aid.&#x0D; Objective. Describe the key concepts of preconception training.&#x0D; Materials and methods. Analysis of literature sources on this topic; own study involving 42 pregnant women (22 women with systemic lupus erythematosus (SLE), 20 women with congenital heart disease (CHD) and hypertensive complications of previous pregnancies), who were divided into two groups. Group 1 received routine drugs and L-arginine (Tivortin, “Yuria-Pharm”) in doses recommended for cardiac patients, and group 2 – only routine drugs.&#x0D; Results and discussion. The components of preconception programs include the individual responsibility of women throughout life, awareness of women, preventive visits, interventions on identified risks, pre-pregnancy examinations and pregnancy supervision, health insurance for low-income women, health programs and strategies, medical research, and the improvement of monitoring. Target groups of preconception include women with unfavorable obstetric history (premature birth, cessation of fetal development, cesarean section, stillbirth, multiple miscarriages, birth of children with birth defects, hypertensive complications of pregnancy) and chronic diseases (type 1 diabetes mellitus, SLE, antiphospholipid syndrome, severe cardiovascular pathology, arterial hypertension, pulmonary hypertension). An important role in the management of pregnant women belongs to the prevention of preeclampsia (PE). Administration of acetylsalicylic acid reduces the likelihood of PE by 10 % in low-risk pregnant women and by 25 % in high-risk pregnant women, but the drug should be started during gestation. The use of calcium (1000 mg) reduces the risk of PE in high-risk pregnant women by 37 %. Preconception preparation is especially important, because some processes, such as the implantation of placental structures, begin and end before a woman learns she is pregnant. Remodeling of the spiral arteries also begins in the early stages of pregnancy, so its correction after the confirmation of pregnancy is less effective than prevention before it occurs. E.E. Camarena Pulido et al. (2016) studied the role of L-arginine (5 tablets of 600 mg per day from the 20th week of gestation before delivery) in the prevention of PE in high-risk women. In the L-arginine group significantly fewer cases of PE (3/49 vs. 11/47 in the placebo group; p=0.01) and a lower incidence of preterm birth were detected. In the another study, pregnant women with chronic hypertension received oral L-arginine or placebo. In the arginine group, there was a lower need for antihypertensive drugs, as well as lower frequency of births before 34 weeks, PE and neonatal complications (Neri I. et al., 2010). In the own study, favorable obstetric results of Tivortin were found. The percentage of births at &gt;37 weeks in the Tivortin group among women with SLE was 90.9 %, and in the group of standard therapy – 50 % (p&lt;0.01), among women with CHD – 90 % and 75 % respectively; p&lt;0.05). No newborns with an Apgar score of &lt;7 were found in the Tivortin group. In the comparison group their number was 27.7 %. Laboratory studies have shown that there is a significant increase in endothelial progenitor cells in the Tivortin group.&#x0D; Conclusions. 1. Preconception preparation of pregnant women is a multifaceted set of measures. 2. A significant number of physiological and pathological processes occur in the early stages of pregnancy, so they can be influenced only in the preconception period. 3. The use of L-arginine during gestation reduces the risk of PE, premature birth and other complications in all women and especially in women with hypertension.

Evaluation of the Efficacy of Low-Dose Acetylsalicylic Acid (Aspirin) in Prevention of Pre-Eclampsia in High-Risk Pregnant Women

Evaluation of the Efficacy of Low-Dose Acetylsalicylic Acid (Aspirin) in Prevention of Pre-Eclampsia in High-Risk Pregnant Women

The antithrombin binding regions of heparin mediate fetal growth and reduced placental damage in the RUPP model of preeclampsia†.

Preeclampsia is a serious hypertensive disorder of pregnancy, which is only cured with delivery of the placenta, thereby commonly necessitating preterm birth of the fetus. Low-molecular-weight heparin (LMWH) has demonstrated potential to reduce the incidence of preeclampsia in high-risk pregnant women, although the underlying mechanism by which LMWH protects against preeclampsia is unknown. Given the complex structure and biologic actions of heparin, we tested the hypothesis that heparin can mediate preeclampsia prevention via nonanticoagulant pathways. We compared the effects of a nonanticoagulant, glycol-split LMWH (gsHep)—rendered nonanticoagulant through disruption of the antithrombin binding regions—with the LMWH dalteparin in the rat reduced uterine perfusion pressure (RUPP) surgical model of preeclampsia. Although RUPP animals exhibit significantly elevated blood pressure and reduced plasma levels of placental growth factor (PGF) compared to sham, neither dalteparin nor gsHep treatment significantly impacted these parameters. However, the observed positive correlation between PGF levels and number of viable fetuses in RUPP-induced animals suggests that reduced PGF levels were predominately due to placental loss. Daily subcutaneous injections of low-dose dalteparin but not gsHep significantly restored fetal growth that was impaired by RUPP surgery. Placentas from RUPP animals exhibited an abnormal labyrinth structure, characterized by expanded sinusoidal blood spaces, relative to sham-operated animals. Morphometric analysis demonstrated that dalteparin but not gsHep treatment normalized development of the labyrinth in RUPP-exposed conceptuses. These data suggest that the antithrombin-binding regions of LMWH are required to confer its protective effects on fetal growth and placental development.

Molecular Targets of Aspirin and Prevention of Preeclampsia and Their Potential Association with Circulating Extracellular Vesicles during Pregnancy.

Uncomplicated healthy pregnancy is the outcome of successful fertilization, implantation of embryos, trophoblast development and adequate placentation. Any deviation in these cascades of events may lead to complicated pregnancies such as preeclampsia (PE). The current incidence of PE is 2–8% in all pregnancies worldwide, leading to high maternal as well as perinatal mortality and morbidity rates. A number of randomized controlled clinical trials observed the association between low dose aspirin (LDA) treatment in early gestational age and significant reduction of early onset of PE in high-risk pregnant women. However, a substantial knowledge gap exists in identifying the particular mechanism of action of aspirin on placental function. It is already established that the placental-derived exosomes (PdE) are present in the maternal circulation from 6 weeks of gestation, and exosomes contain bioactive molecules such as proteins, lipids and RNA that are a “fingerprint” of their originating cells. Interestingly, levels of exosomes are higher in PE compared to normal pregnancies, and changes in the level of PdE during the first trimester may be used to classify women at risk for developing PE. The aim of this review is to discuss the mechanisms of action of LDA on placental and maternal physiological systems including the role of PdE in these phenomena. This review article will contribute to the in-depth understanding of LDA-induced PE prevention.

Aspirin and heparin for the prevention of pre-eclampsia: protocol for a systematic review and network meta-analysis

IntroductionPre-eclampsia is an important cause of death and complication for pregnant women and perinatal infant. Low-dose aspirin has been most commonly used to prevent pre-eclampsia in high-risk pregnant women. Recently,...

Aspirin in Preeclampsia: Current Evidence and Future Scope of Research

Maternal mortality remains a global health problem. Preeclampsia and eclampsia, major hypertensive disorders in pregnancy, remain the fourth leading cause of maternal mortality. The role of aspirin to prevent preeclampsia has been explored in the last 3 decades. This article summarizes the various studies done so far on the role of aspirin in preeclampsia and seeks to develop a hypothesis regarding the indication, dose and efficacy of aspirin therapy in the prevention of preeclampsia. Aspirin, when administered at 12–20 weeks of gestation at a dose of 75–150 mg seems to have a role in primary and secondary prevention of preeclampsia in high-risk pregnant women. The existing screening algorithms for preeclampsia have a high false positive rate. Therefore, a need for further research to develop a better screening algorithm for detection of women at a high risk of preeclampsia is warranted. The results, from the recent Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention (ASPRE) study, reported better prevention of preeclampsia with a 150 mg dose of aspirin. Hence, more data from multicentric randomized controlled trials are required to establish the safety and higher effect size of 120–150 mg dose aspirin compared to the 75–100 mg dose of aspirin for prevention of preterm preeclampsia.