Prevention Of Preeclampsia In Women Research Articles

Obstetric care provider’s knowledge about the use of low dose aspirin for preeclampsia prevention in low and middle income countries: a systematic review and meta-analysis

Introduction: Preeclampsia can elevate the likelihood of unfavorable consequences for a mother, such as severe morbidity and mortality. World Health Organization recommends low dose acetylsalicylic acid (aspirin, 75 mg per day) for the prevention of preeclampsia in women at moderate or high risk of developing the condition. The use of low dose aspirin is dependent on the knowledge of health care providers working in the antenatal care units. We found inconsistent figures regarding the knowledge level of health care providers on low dose aspirin for preeclampsia prevention around different low and middle income countries in the world. Thus, determining the pooled knowledge level of health care providers is very important.MethodsThis systematic review and meta-analysis (SRMA) was conducted on the knowledge level of among obstetric care providers towards preeclampsia prevention in low and middle income countries. We identified relevant literature in the English language only. A comprehensive search was conducted on databases such as PubMed, Google Scholar, HINARI, and Scopus. Subsequently, all datasets were exported to Mendeley reference manager and transferred to a Microsoft Excel spreadsheet to eliminate duplicate data during the review process. The extracted Microsoft Excel spreadsheet format data was imported to STATA software version 17 (STATA corporation, Texas, USA) for analysis. Then random effect model was used to estimate the pooled level of knowledge of health care providers on low dose aspirin for preeclampsia prevention in low income countries. Cochrane Q-test and I2 statistics were computed to assess heterogeneity among all the studies included in this SRMA.ResultA total of 1231 articles were identified through our search strategies, including Google Scholar, PubMed, Hinari and Scopus. Ultimately, six articles met the eligibility criteria for inclusion in the final SRMA. The pooled knowledge level of healthcare providers regarding the use of low-dose aspirin for preeclampsia prevention in low-income countries was found to be 16.38% (95% CI: 4.36–28.40). The Cochrane heterogeneity index, with a substantial I2 value of 98.89% and a significant P-value of 0.01, indicated significant heterogeneity among the primary studies included.Conclusionthe knowledge level of obstetric care providers in low and middle income countries is found very low and all the governmental and non-governmental organizations should strive to enhance the knowledge of obstetric care providers on the use of low dose aspirin for preeclampsia prevention in low and middle income countries.

Aspirin 162 mg vs 81 mg for preeclampsia prophylaxis in high-risk obese individuals: a comparative effectiveness open-label randomized trial (ASPREO)

In the United States, leading medical societies recommend 81 mg of aspirin daily for the prevention of preeclampsia in women at risk, whereas the NICE guidelines in the United Kingdom recommend a dose as high as 150 mg of aspirin. Recent data also suggest that in the obese population, inadequate dosing or aspirin resistance may impact the efficacy of aspirin at the currently recommended doses. We evaluated whether daily administration of 162 mg aspirinwould be more effective compared with 81 mg in decreasing the rate ofpreeclampsia with severe features in high-risk obese pregnant individuals. We performed a randomized trial between May 2019 and November 2022. Individuals at 12-20 weeks of gestational age with a body mass index ≥30 kg/m2 at the time of enrollment and at least 1 of 3 high-risk factors: history of preeclampsia in a prior pregnancy, at least stage I hypertension documented in the index pregnancy, pregestational diabetes or gestational diabetes diagnosed before 20 weeks of gestational age were randomized to either 162 mg or 81 mg of aspirin daily till delivery, participants were not blinded to treatment allocation. Exclusion criteria were multifetal gestation, known major fetal anomalies, seizure disorder, baseline proteinuria, on aspirin because of other indications, or contraindication to aspirin. The primary outcome was preeclampsia with severe features (preeclampsia or superimposed preeclampsia with severe features; eclampsia; or hemolysis, elevated liver enzymes, low platelet count syndrome). Secondary outcomes included rates of preterm birth because of preeclampsia, small for gestational age, postpartum hemorrhage, abruption, and medication side effects. A sample size of 220 was needed using a preplanned Bayesian analysis of the primary outcome to estimate the posterior probability of benefit or harm with a neutral informative prior. Approximately 220/343 (64.1%) individuals were randomized. The primary outcome was available for 209/220 (95%) individuals. Baseline characteristics were similar between groups, with the median gestational age at enrollment being 15.9 weeks in the 162 mg aspirin group and 15.6 weeks in the 81 mg aspirin group. Enrollment before 16 weeks occurred in 55 of 110of those assigned to 162 mg and 58 of 110 of those assigned to 81 mg ofaspirin. The primary outcome occurred in n of d individuals (35%) in the 162mg aspirin group and n of d individuals (40%) in the 81 mg aspirin group (posterior relative risk, 0.88; 95% credible interval, 0.64-1.22). Bayesian analysis indicated a 78% probability of a reduction in the primary outcome with 162 mg aspirin compared with 81 mg aspirin dose. Rates of indicated pretermbirth because of preeclampsia (21% vs 21%), small for gestational age (6.5% vs 2.9%), abruption (2.8% vs 3.0%), and postpartum hemorrhage (10.0% vs 8.8%) were similar between groups. Medication adverse effects were also similar. Among high-risk obese individuals, there was a 78% probability of benefit that 162 mg aspirin compared with 81 mg will decrease the rate of preeclampsia with severe features. With the best estimate of a 12% reduction when using 162 mg of aspirin compared with 81 mg of aspirin in this population. This trial supports doing a larger multicenter trial.

Prediction and prevention of preeclampsia in women with preexisting diabetes: the role of home blood pressure, physical activity, and aspirin.

Women with type 1 or type 2 (preexisting) diabetes are four times more likely to develop preeclampsia compared with women without diabetes. Preeclampsia affects 9%-20% of pregnant women with type 1 diabetes and 7%-14% of pregnant women with type 2 diabetes. The aim of this narrative review is to investigate the role of blood pressure (BP) monitoring, physical activity, and prophylactic aspirin to reduce the prevalence of preeclampsia and to improve pregnancy outcome in women with preexisting diabetes. Home BP and office BP in early pregnancy are positively associated with development of preeclampsia, and home BP and office BP are comparable for the prediction of preeclampsia in women with preexisting diabetes. However, home BP is lower than office BP, and the difference is greater with increasing office BP. Daily physical activity is recommended during pregnancy, and limiting sedentary behavior may be beneficial to prevent preeclampsia. White coat hypertension in early pregnancy is not a clinically benign condition but is associated with an elevated risk of developing preeclampsia. This renders the current strategy of leaving white coat hypertension untreated debatable. A beneficial preventive effect of initiating low-dose aspirin (150 mg/day) for all in early pregnancy has not been demonstrated in women with preexisting diabetes.

Metformin for pre-eclampsia prevention in women with BMI > 30

Metformin for pre-eclampsia prevention in women with BMI > 30

Calcium for pre-eclampsia prevention: A systematic review and network meta-analysis to guide personalised antenatal care.

Calcium supplementation reduces the risk of pre-eclampsia, but questions remain about the dosage to prescribe and who would benefit most. To evaluate the effectiveness of high (≥1g/day) and low (<1g/day) calcium dosing for pre-eclampsia prevention, according to baseline dietary calcium, pre-eclampsia risk and co-interventions, and intervention timing. CENTRAL, PubMed, Global Index Medicus and CINAHL, from inception to 2 February 2021, clinical trial registries, reference lists and expert input (CRD42018111239). Randomised controlled trials of calcium supplementation for pre-eclampsia prevention, for women before or during pregnancy. Network meta-analysis (NMA) also included trials of different calcium doses. Two independent reviewers extracted published data. The meta-analysis employed random-effects models and the NMA, a Bayesian random-effects model, to obtain direct and indirect effect estimates. The meta-analysis included 30 trials (N=20 445 women), and the NMA to evaluate calcium dosage included 25 trials (N=15 038). Calcium supplementation prevented pre-eclampsia similarly with a high dose (RR0.49, 95%CI 0.36-0.66) or a low dose (RR0.49, 95%CI 0.36-0.65). By NMA, high-dose (vs low-dose) calcium did not differ in effect (RR0.79, 95%CI 0.43-1.40). Calcium was similarly effective regardless of baseline pre-eclampsia risk, vitamin D co-administration or timing of calcium initiation, but calcium was ineffective among women with adequate average baseline calcium intake. Low- and high-dose calcium supplementation are effective for pre-eclampsia prevention in women with low calcium intake. This has implications for population-level implementation where dietary calcium is low, and targeted implementation where average intake is adequate. A network meta-analysis of 25 trials found that low-dose calcium supplementation (<1g/day) is as effective as high-dose calcium supplementation (≥1g/day) in halving the risk of pre-eclampsia when baseline calcium intake is low.

55. Prevention of preeclampsia in women with multiple pregnancy after assisted reproduction

Objective: To reduce the frequency and severity of preeclampsia (PE), to improve obstetrical and perinatal outcomes in women with multiple pregnancy after assisted reproduction by the development and implementation of the preventive algorithm with biochemical markers of endothelial dysfunction prospective analysis. Study design: Prospective analysis of 54 cases of twins in women, treated from infertility with assisted reproductive technologies (ART), using the method of intracytoplasmic sperm injection and frozen embryos transfer, have been made.

Provider Adherence to Aspirin Prophylaxis Prescription Guidelines for Preeclampsia Prevention - A Quality Improvement Project

Preeclampsia affects 2-8% of pregnancies leading to significant maternal and neonatal morbidity and mortality. The Society for Maternal-Fetal Medicine supports the use of low dose aspirin for the prevention of preeclampsia in women at risk. The aim of this study was to evaluate provider adherence to aspirin prophylaxis prescription guidelines for women at risk.

Aspirin in the prevention of preeclampsia: A protocol for systematic review and meta analysis.

Introduction:Aspirin is widely used to prevent pregnancy related vascular disorders such as preeclampsia (PE), intrauterine growth restriction and maternal disorders. However, the indications for the use of aspirin during pregnancy is currently controversial because the dosage of aspirin used and the sample sizes in various studies differ considerably. Furthermore, women of African ancestry are more likely to have higher rates of PE and more severe cases than those of their Caucasian counterparts. Yet, there are very few studies in this population group. Therefore, the aim of this review will be to determine the effect of low-dose aspirin (LDA) for prevention of PE in women of African ancestry.Methods and Analysis:This is a protocol for a systematic review and meta-analysis of published studies on the effect of LDA for prevention of PE. Relevant information will be accessed from the following databases; PubMed, Cochrane Central Register of Controlled Trials, Google Scholar, Google, EBSCO Host, and the Web of Science. The studies will be mapped in 2 stages: stage 1 will map studies descriptively by focus and method; stage 2 will involve additional inclusion criteria, quality assessment and data extraction undertaken by 2 reviewers in parallel. Evidence will be synthesized using relevant systematic research tools. Meta-analysis and subgroup analysis will be conducted using RevMan whilst Stata 13 will be used for meta-regressions. We will follow recommendations described in the preferred reporting items for systematic reviews and meta-analyses statement and the Cochrane Handbook for Intervention Reviews.Discussion:The use of LDA as a prophylactic treatment has been considered for the prevention of PE. However, studies evaluating the use of LDA in women of African ancestry are few. Therefore, with the increase in the prevalence of PE in the African population, it is critical to further investigate the use of LDA in pregnant women of African ancestry.Ethics and dissemination:The review and meta-analysis will not require ethical approval and the findings will be published in peer-reviewed journals and presented at local and international conferences. The findings of this review will inform all stakeholders on current and future guidelines on the use of aspirin in pregnancy, especially in populations of African ancestry.Systematic review registration:International prospective Register of Systematic Reviews (PROSERO) number: (CRD42020213213).

Efficacy of Low Doses of Acetylsalicylic Acid in the Prevention of Preeclampsia in Women with Type 1 and 2 Diabetes Mellitus

Background: The effective approach to preventing preeclampsia (PE) is administering acetylsalicylic acid (ASA) to high-risk patients. However, there are not enough data analyzing the effectiveness of ASA intake by pregnant women with diabetes mellitus (DM). This study aims to evaluate the effect of ASA on perinatal outcomes in pregnant women with different types of pregestational DM. Methods: This retrospective study included 735 pregnant women with DM (types 1 and 2). At 12–14 weeks of gestation, some patients were prescribed daily ASA at a 100–150 mg dose continuously for up to 36 weeks. The effect of ASA on the development of PE and other outcomes of pregnancy was assessed. The times of delivery and the onset of PE were evaluated as well. Results: When taking ASA, PE developed significantly less frequently in pregnant women with DM. This was significantly more evident in patients with type 2 DM (OR 0.65; 95% CI: 0.52–0.79). In patients with type 1 DM, the mean period of development of PE was 1.5 weeks later relative to those pregnant women who did not take the drug and was 35.5 weeks of gestation. The OR for the development of preterm birth was reduced by 3 times (OR 0.33; 95% CI: 0.15–0.62). In women with DM who took ASA during pregnancy, babies were born with greater body weight, and the frequency of small for gestational age births decreased. Conclusions: ASA administration is associated with a reduction of the incidence of PE, a delay in its manifestations, and a mitigating the risk of other adverse perinatal outcomes typical for pregnant women with DM.

A randomized controlled trial of low-dose aspirin for the prevention of preeclampsia in women at high risk in China

Low-dose aspirin has been the most widely studied preventive drug for preeclampsia. However, guidelines differ considerably from country to country regarding the prophylactic use of aspirin for preeclampsia. There is limited evidence from large trials to determine the effect of 100 mg of aspirin for preeclampsia screening in women with high-risk pregnancies, based on maternal risk factors, and to guide the use of low-dose aspirin in preeclampsia prevention in China. The Low-Dose Aspirin in the Prevention of Preeclampsia in China study was designed to evaluate the effect of 100 mg of aspirin in preventing preeclampsia among high-risk pregnant women screened with maternal risk factors in China, where preeclampsia is highly prevalent, and the status of low-dose aspirin supply is commonly suboptimal. We conducted a multicenter randomized controlled trial at 13 tertiary hospitals from 11 provinces in China between 2016 and 2019. We assumed that the relative reduction in the incidence of preeclampsia was at least 20%, from 20% in the control group to 16% in the aspirin group. Therefore, the targeted recruitment number was 1000 participants. Women were randomly assigned to the aspirin or control group in a 1:1 allocation ratio. Statistical analyses were performed according to an intention-to-treat basis. The primary outcome was the incidence of preeclampsia, diagnosed along with a systolic blood pressure of ≥140 mm Hg or a diastolic blood pressure of ≥90 mm Hg after 20 weeks of gestation, with a previously normal blood pressure (systolic blood pressure of <140 mm Hg and diastolic blood pressure of <90 mm Hg), and complicated by proteinuria. The secondary outcomes included maternal and neonatal outcomes. Logistic regression analysis was used to determine the significance of difference of preeclampsia incidence between the groups for both the primary and secondary outcomes. Interaction analysis was also performed. A total of 1000 eligible women were recruited between December 2016 and March 2019, of which the final 898 patients were analyzed (464 participants in the aspirin group, 434 participants in the control group) on an intention-to-treat basis. No significant difference was found in preeclampsia incidence between the aspirin group (16.8% [78/464]) and the control group (17.1% [74/434]; relative risk, 0.986; 95% confidence interval, 0.738-1.317; P=.924). Likewise, adverse maternal and neonatal outcomes did not differ significantly between the 2 groups. Meanwhile, the incidence of postpartum hemorrhage between the 2 groups was similar (6.5% [30/464] in the aspirin group and 5.3% [23/434] in the control group; relative risk, 1.220; 95% confidence interval, 0.720-2.066; P=.459). We did not find any significant differences in preeclampsia incidence between the 2 groups in the subgroup analysis of the different risk factors. A dosage of 100 mg of aspirin per day, initiated from 12 to 20 gestational weeks until 34 weeks of gestation, did not reduce the incidence of preeclampsia in pregnant women with high-risk factors in China.

PECULIARITIES OF PREGNANCY COURSE IN WOMEN WITH CONCOMITANT OBESITY WHO TAKE THERAPEUTIC AND PROPHYLACTIC COMPLEX AIMED TO PREVENT PREECLAMPSIA

The rapid growth in the incidence of overweight and obesity among women of childbearing age is posing specific issues related to their pregnancy, thereupon choosing adequate and effective tactics for the prevention of preeclampsia in women with concomitant obesity who are at high risk group for this complication is of undoubted relevance. The aim of this study is to assess the occurrence and characteristic of obstetric and prenatal complications in women with concomitant obesity, who receive therapeutic and prophylactic complex designed to prevent the development of preeclampsia. We studied the course of pregnancy of 255 women, who were divided into 3 groups according to the class of obesity, and then, in turn, were subdivided into subgroups taking into account the presence of preeclampsia and the therapeutic and prophylactic complex course. The high efficiency of the therapeutic and prophylactic complex including L-arginine and diosmin for obese women enables to reduce the manifestations of endothelial dysfunction, the occurrence of preeclampsia and its severe forms; to lower down the occurrence of other complications during the pregnancy (risks of premature birth, placental insufficiency, distress and foetal growth retardation); to avoid perinatal mortality and improve the condition of the foetus. Applying this pathogenetically grounded therapeutic and prophylactic complex we elaborated (acetylsalicylic acid, L-arginine, calcium supplements and semisynthetic diosmin) to prevent the occurrence of preeclampsia in pregnant women with concomitant obesity, who are at high-risk group, promotes the reduction of occurrence and intensity of obstetric and prenatal complications resulted from endothelial dysfunction. We can suggest the therapeutic and prophylactic complex for pregnant women with concomitant obesity as effective therapy because no cases of severe and early preeclampsia have been registered.

The Role of Aspirin for Preeclampsia Prevention in Women with Diabetes.

A diagnosis of type I or type 2 diabetes confers heightened risk for virtually every obstetric and perinatal complication, with the incidence of superimposed preeclampsia representing a particularly high-risk scenario. Over the past three decades, studies have investigated the role of aspirin in preeclampsia prevention, yielding some promising results for certain at-risk groups, yet unconvincing evidence of benefit among women with pre-pregnancy diabetes. The purpose of this review is to present the current evidence base for aspirin use in pregnancy as a means of mitigating preeclampsia risk in the setting of pregestational type I or type 2 diabetes. Meta-analysis data examining low-dose aspirin for preeclampsia prevention in at-risk and low-risk women has demonstrated modest benefit, but subanalyses of cohorts with diabetes have failed to demonstrate a beneficial effect. Evidence is emerging that indicates a benefit only among women who initiate aspirin therapy prior to 16weeks' gestation, and uncertainty exists surrounding the effective dose. In light of equipoise surrounding the potential role of aspirin for prevention of preeclampsia in women with diabetes, current research is targeted at determining clinical efficacy of aspirin in this high-risk obstetric population.

Aspirin to Prevent Preeclampsia

Background: Pre-eclampsia is a major cause of mortality and morbidity during pregnancy and childbirth. There are recommendations on use of medications to prevent preeclampsia, including low dose aspirin.&#x0D; Objective: The objective of this review is to discuss role of aspirin in reducing the incidence and maternal mortality and morbidity due to preeclampsia including its dose and duration of use.&#x0D; Methods: Review of available literature in internet and from libraries.&#x0D; Results: Four large randomized trials have demonstrated a reduction in the incidence of preeclampsia in patients treated with low-dose aspirin prophylaxis compared with placebo/ no treatment (15 versus 19 percent, 18 versus 20 percent, 6.7 versus 7.6 percent, and 1.6 versus 4.3 percent); however, the results were statistically significant in only the last trial. When data from these and other trials were pooled, meta-analyses supported the significance of the trend observed in individual trials. When begun early in the second trimester, use of low-dose aspirin (75-150 mg) reduced the incidence of preeclampsia by at least 10 percent, with the greatest absolute benefit in women at moderate to high risk of developing the disease. Serious sequelae of early onset preeclampsia, such as preterm birth and fetal growth restriction, were also reduced.&#x0D; Conclusion: Low-dose aspirin reduces the frequency of preeclampsia, as well as related adverse pregnancy outcomes (preterm birth, growth restriction), by about 10 to 20 percent when given to women at moderate to high risk of the disease. It has an excellent maternal/ fetal safety profile in pregnancy. WHO recommends Low-dose acetylsalicylic acid (aspirin, 75 mg) for the prevention of preeclampsia in women at high risk of developing the condition; should be initiated before 20 weeks of pregnancy. It should be taken preferably from 13th week of pregnancy, daily, regularly and may be discontinued 5 to 10 days before delivery.&#x0D; Bangladesh J Obstet Gynaecol, 2017; Vol. 32(2) : 106-116

Abstract MP64: The Role of Aspirin in the Relationship Between Hypertensive Disorders of Pregnancy and Incident Maternal Cardiovascular Disease

Introduction: Hypertensive disorders of pregnancy (HDP; including gestational hypertension and preeclampsia) are associated with an increased risk of maternal cardiovascular disease (CVD). Low-dose aspirin reduces the risk of preterm preeclampsia, through proposed short-term effects on platelet and endothelial function. While low-dose aspirin is recommended for the prevention of preeclampsia in women at high risk, no recommendations exist for aspirin use following a pregnancy complicated by HDP. Hypothesis: We hypothesized that regular aspirin use after pregnancy would modify the association between HDP and CVD, lowering the magnitude of the association among aspirin users relative to non-users. Methods: Parous women free of CVD before first birth in the Nurses’ Health Study II comprised the analytic sample (n=60,392). Lifetime pregnancy history was reported in 2009. Women were followed for confirmed incident CVD (coronary heart disease [non-fatal or fatal MI, fatal CHD] or stroke [non-fatal or fatal]) from 1989 through 2013. Current regular aspirin use was self-reported at baseline in 1989 and updated every 2 years via biennial questionnaire. We used Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the relationship between HDP in first pregnancy (using 3 mutually exclusive categories: normotension [ref], gestational hypertension, preeclampsia) and CVD, adjusted for age, race/ethnicity, parental education, family history of CVD &lt;60y, and pre-pregnancy risk factors (smoking, physical activity, diet, alcohol intake, oral contraceptive use, BMI). Effect modification by aspirin was tested through a likelihood ratio test, comparing nested models with and without interaction terms between HDP history and time-varying aspirin use. Results: Nine percent of women (n=5,629) had HDP in first pregnancy. CVD events occurred in 657 women with normotension, 30 women with gestational hypertension, and 75 women with preeclampsia. Compared to women with normotension in first pregnancy, gestational hypertension was associated with stroke (HR=1.65; CI: 1.01-2.71) but not CHD (HR=1.21; CI: 0.70-2.12), while preeclampsia was associated with CHD (HR=2.27; CI: 1.69-3.04) but not stroke (HR=1.03; CI: 0.68-1.57). Current aspirin use was not a significant effect modifier of the relationship between HDP and CVD (p-value=0.53). Hazard ratios for the relationship between gestational hypertension and CVD were 1.58 (CI: 1.01-2.49) among aspirin non-users and 1.15 (CI: 0.61-2.18) among aspirin users. Hazard ratios for the relationship between preeclampsia and CVD were 1.52 (CI: 1.10-2.10) among aspirin non-users and 1.67 (CI: 1.16-2.40) among aspirin users. Conclusion: Aspirin use after pregnancy does not appear to modify the increased risk of CVD observed among women with a history of HDP compared to women with normotension in pregnancy.

Possibilities for prediction and prevention of preeclampsia in women with diabetes mellitus

Based on the analysis of literature data, the role and serum levels of the main angiogenic (placental growth factor (PlGF)) and antiangiogenic vascular factors (endoglin (sENG), soluble fms-like type 1 tyrosine kinase (sFlt-1)) have been assessed in pregnant women with different types of diabetes mellitus (DM) in both the plasma and placenta. We evaluated the effectiveness of administration of low doses of acetylsalicylic acid for preventing preeclampsia in diabetic pregnancy. In addition, the effectiveness of using the sFlt-1/PlGF and PlGF/sENG ratios as possible test systems for prediction of the complication in this patient population was evaluated. It has been found that the synthesis of the studied biomarkers fails in the diabetic pregnancy, with the expression levels of sENG and sFlt-1 increased and PlGF reduced. However, the insufficient research does not allow us to make unambiguous conclusions about the practical validity of the evaluation of the plasma content of these vascular factors and their ratios for the preeclampsia prediction in pregnant women with DM. The presented data on acetylsalicylic acid administration to these women are also controversial. Given the high incidence of adverse perinatal outcomes associated with DM during pregnancy, an additional assessment of the prognostic risk model for the development of preeclampsia and the appropriateness of aspirin administration is needed. Therefore, further randomized studies are required to address this issue.

Effect of high dose folic acid supplementation in pregnancy on pre-eclampsia (FACT): double blind, phase III, randomised controlled, international, multicentre trial

ObjectiveTo determine the efficacy of high dose folic acid supplementation for prevention of pre-eclampsia in women with at least one risk factor: pre-existing hypertension, prepregnancy diabetes (type 1 or 2),...

Ácido acetilsalicílico na prevenção da pré-eclâmpsia: uma revisão baseada na evidência

Objectives: To review the current evidence for the effectiveness of aspirin in preventing preeclampsia. Data sources: MEDLINE and evidence-based medicine websites. Methods: We searched for clinical practice guidelines (CPG), randomized controlled trials (RCT), systematic reviews (SR) and meta-analyzes (MA), published between 13/11/2005 and 13/11/2015, using the MESH terms ‘pre-eclampsia’ and ‘aspirin’ and the Portuguese DeCS terms ‘pre-eclâmpsia’ and ‘aspirina’. The Strength of Recommendation Taxonomy (SORT) of American Academy of Family Physicians was used for the assignment of levels of evidence (LE) and the strength of recommendations (SOR). Results: A total of 14 articles were selected for this review out of 296 articles found. These included seven MA, three SR, three CPG and one RCT. The SR and MA found benefits for aspirin in the prevention of preeclampsia, particularly in women at high-risk. One SR with LE 2 found no evidence to support the use of aspirin prophylaxis in women at risk for preeclampsia. Studies that analyzed women at low-risk separately found no benefit from the use of aspirin in this group of women. The CPG recommend the use of aspirin in the prevention of preeclampsia in high-risk women and discouraged its use in low-risk women. The RCT supported the same recommendation for high-risk women. Conclusions: The available evidence suggests that low-dose aspirin is effective for the prevention of preeclampsia in women at risk. There is clear evidence of its benefit in high-risk women (SOR A) and its use is discouraged in low-risk women (SOR A). There is still a need for more high quality studies with similar methods conducted in relevant populations to support these recommendations.

Rate of Gestational Diabetes Mellitus and Pregnancy Outcomes in Patients with Chronic Hypertension.

Objective This study aims to determine the rate of gestational diabetes mellitus (GDM) in pregnancies complicated by chronic hypertension and to compare the adverse outcomes in chronic hypertensive pregnancies with and without GDM. Study Design A secondary analysis from a multicenter trial of low-dose aspirin for preeclampsia prevention in women with chronic hypertension. The rate of GDM was evaluated among singleton pregnancies complicated with chronic hypertension and grouped according to their GDM status. Pregnancy outcomes and rates of preterm delivery < 35 weeks and < 32 weeks, preeclampsia, indicated preterm birth, small for gestational age, abruptio placentae, and perinatal death were compared between those with and without GDM. A subgroup analysis comparing women who developed superimposed preeclampsia with and without GDM was studied. Multivariate logistic-regression analysis was used to adjust for potentially confounding factors. Results A total of 763 women met the inclusion criteria: 129 (17%) developed GDM. Parity, race, maternal baseline blood pressure, antihypertensive drug use, and assignment to low-dose aspirin were not significantly different between the groups with and without GDM. Using univariate analysis, maternal age (33 vs. 24%, p = 0.03) and body mass index (88 vs. 57%, p < 0.001) were higher in those who had GDM, whereas the rate of preterm delivery < 32 weeks (12 vs. 5%, p = 0.02) was higher among those without GDM. Using logistic-regression analysis, the rate of composite adverse outcomes (adjusted odds ratio [aOR], 0.77; 95% confidence interval [CI], 0.41-1.47) that included indicated preterm birth, small for gestational age, abruptio placentae, and perinatal death showed no significant differences.Superimposed preeclampsia developed in 34 (26%) women with GDM and in 182 (29%) without GDM. When superimposed preeclampsia was present, it developed at an earlier gestational age among the group without GDM (35 ± 5 vs. 37 ± 3 weeks, p = 0.003), and had higher rates of small for gestational age infants (18 vs. 3%, p = 0.03). After adjustment for confounders, only length of stay in neonatal intensive care unit was longer for those without GDM who developed superimposed preeclampsia (aOR, 0.42; 95% CI, 0.2-0.93). Conclusion Women with chronic hypertension are at a high risk for developing GDM. Outcomes in patients with chronic hypertension and GDM are not significantly different from those with chronic hypertension only.

Возможности снижения риска развития преэклампсии (обзор зарубежной литературы)

The article presents a review of international literature on the possibilities of prevention of pre-eclampsia in women at high risk. Given data from recent randomized trials and meta-analyses, have confirmed whether the use of low-dose antiplatelet therapy with 12 weeks of pregnancy to prevent the development of pre-eclampsia.

Maternal serum 25‐hydroxyvitamin D and fetal growth in a multicenter US study

We examined the association between maternal serum 25‐ hydroxyvitamin D [25(OH)D] levels and measures of newborn size. Data came from a randomized controlled trial of aspirin for the prevention of preeclampsia in women at high risk for the disorder in 13 US medical centers. A total of 574 women delivered singleton, live births at term and had a serum sample drawn at ≤26 weeks gestation. Serum 25(OH)D was assayed with LC/MS‐MS. Multivariable linear and logistic regression models were used to assess the association between 25(OH)D and birth weight, length, head circumference, and risk of small‐for‐gestational‐age after adjustment for maternal prepregnancy BMI, race/ethnicity, age, gestational age at blood draw, and treatment allocation. Median birth weight was lower for women with 25(OH)D &lt;30 nmol/L vs. ≥50 nmol/L (3200 g vs. 3395 g, p=0.004). After adjustment for confounders, 25(OH)D &lt;30 nmol/L vs. ≥50 nmol/L was associated with a 168 g decrease in birth weight (95% CI: −301, −34). Furthermore, 25(OH)D 30–49 nmol/L vs. ≥50 nmol/L was associated with a 0.63 cm decrease in length (95% CI: −1.16, – 0.11). No association was observed for head circumference or risk of small‐for‐gestational‐age. Our results suggest that maternal vitamin D status may influence physiologic fetal growth in full term infants of high risk mothers. Supported by the National Institutes of Health grant HD056999 (PI: Dr. Bodnar).