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Erschienen in: The Journal of Obstetrics and Gynecology of India 1/2020

20.09.2019 | Original Article

Pilot Interventional Study Comparing Fetomaternal Outcomes of 150 mg Versus 75 mg Aspirin Starting Between 11 and 14 Weeks of Pregnancy in Patients with High Risk of Preeclampsia: A Randomized Control Trial

verfasst von: Namrata Kumar, Vinita Das, Anjoo Agarwal, Amita Pandey, Smriti Agrawal, Amrita Singh

Erschienen in: The Journal of Obstetrics and Gynecology of India | Ausgabe 1/2020

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Abstract

Introduction

Hypertensive disorders of pregnancies complicate around 5–10% of pregnancies worldwide, and together they are a member of the deadly triad along with haemorrhage and infection that contribute to a significant amount of maternal morbidity and mortality.

Aims and Objectives

To compare differences in the fetomaternal outcomes with the use of 150 mg aspirin versus 75 mg aspirin in pregnant women found to be at high risk of PE.

Methodology

This was a two-armed double-blind parallel randomized control trial conducted in the Department of Obstetrics and Gynaecology, King George’s Medical University, carried over a period of 1 year.

Results

Preeclampsia occurred in 15 of 87 participants (17%) in the 75 mg aspirin group compared with 6 of 91 (6.5%) in the 150 mg aspirin group. There were a significantly higher incidence of PE, its severity and lesser period of gestation at delivery in the group given 75 mg dose compared to the group given 150 mg dose. There were significantly higher values of mean arterial pressure and uterine artery PI in women who developed preeclampsia compared to those who do not in both the groups. Foetal outcomes were observed in both the groups of women, and there was no statistically significant difference between them.

Conclusion

This randomized trial showed that among women with singleton pregnancies who were identified by means of first-trimester screening as being at high risk of preterm preeclampsia, use of aspirin 150 mg per day started between 11 and 14 weeks till 36 weeks is a potent intervention to reduce the development of both early- and late-onset preeclampsia as compared to a dose of 75 mg per day.
Literatur
1.
Zurück zum Zitat Cunningham GF, Leveno KJ, Bloom SL, et al. Williams obstetrics. 24th ed. New York: McGraw-Hill; 2014. Cunningham GF, Leveno KJ, Bloom SL, et al. Williams obstetrics. 24th ed. New York: McGraw-Hill; 2014.
2.
Zurück zum Zitat Plasencia W, Maiz N, Bonino S, et al. Uterine artery Doppler at 11 + 0 to 13 + 6 weeks in the prediction of pre-eclampsia. Ultrasound Obstet Gynecol. 2007;30:742–9.CrossRef Plasencia W, Maiz N, Bonino S, et al. Uterine artery Doppler at 11 + 0 to 13 + 6 weeks in the prediction of pre-eclampsia. Ultrasound Obstet Gynecol. 2007;30:742–9.CrossRef
3.
Zurück zum Zitat Yu CKH, Khouri O, Onwudiwe N, et al. Prediction of pre-eclampsia by uterine artery Doppler imaging : relationship to gestational age at delivery and small for gestational age. Ultrasound Obstet Gynecol. 2008;31:310–3.CrossRef Yu CKH, Khouri O, Onwudiwe N, et al. Prediction of pre-eclampsia by uterine artery Doppler imaging : relationship to gestational age at delivery and small for gestational age. Ultrasound Obstet Gynecol. 2008;31:310–3.CrossRef
4.
Zurück zum Zitat Walsh CA, Bakshi LV. Mean arterial pressure and prediction of pre-eclampsia. Br Med J. 2008;336(7653):1079–80.CrossRef Walsh CA, Bakshi LV. Mean arterial pressure and prediction of pre-eclampsia. Br Med J. 2008;336(7653):1079–80.CrossRef
5.
Zurück zum Zitat Akolekar R, Syngelaki A, Sarquis R, et al. Prediction of early, intermediate and late preeclampsia from maternal factors, biophysical and biochemical markers at 11–13 weeks. Prenat Diagn. 2011;31:66–74.CrossRef Akolekar R, Syngelaki A, Sarquis R, et al. Prediction of early, intermediate and late preeclampsia from maternal factors, biophysical and biochemical markers at 11–13 weeks. Prenat Diagn. 2011;31:66–74.CrossRef
6.
Zurück zum Zitat Goetzinger KRG, Singla A, Gerkowicz S, et al. Predicting the risk of pre-eclampsia between 11 and 13 weeks gestation by combining maternal characteristics and serum analytes, PAPP-A and free β-Hcg. Prenat Diagn. 2010;30(12–13):1138–42.CrossRef Goetzinger KRG, Singla A, Gerkowicz S, et al. Predicting the risk of pre-eclampsia between 11 and 13 weeks gestation by combining maternal characteristics and serum analytes, PAPP-A and free β-Hcg. Prenat Diagn. 2010;30(12–13):1138–42.CrossRef
7.
Zurück zum Zitat Gomez O, Figuerats F, Fernandez S, et al. Reference ranges for uterine artery mean pulsatility index at 11–41 weeks of gestation. Ultrasound Obstet Gynecol. 2008;32:128–32.CrossRef Gomez O, Figuerats F, Fernandez S, et al. Reference ranges for uterine artery mean pulsatility index at 11–41 weeks of gestation. Ultrasound Obstet Gynecol. 2008;32:128–32.CrossRef
8.
Zurück zum Zitat Ridding G, Schluter PJ, Hyett JA, et al. Uterine artery pulsatality index assessment at 11–13+6 weeks gestation. Fetal Diagn Ther. 2014;36:299–304.CrossRef Ridding G, Schluter PJ, Hyett JA, et al. Uterine artery pulsatality index assessment at 11–13+6 weeks gestation. Fetal Diagn Ther. 2014;36:299–304.CrossRef
9.
Zurück zum Zitat Askie LM, Lelia D, Henderson SDJ, et al. Antiplatelet agents for prevention of pre-eclampsia: a metaanalysis of individual patient data. Lancet. 2007;369(9575):1791–8.CrossRef Askie LM, Lelia D, Henderson SDJ, et al. Antiplatelet agents for prevention of pre-eclampsia: a metaanalysis of individual patient data. Lancet. 2007;369(9575):1791–8.CrossRef
10.
Zurück zum Zitat Bujold E, Roberge S, Lacasse Y, et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy : a metaanalysis. Obstet Gynecol. 2010;116:402–14.CrossRef Bujold E, Roberge S, Lacasse Y, et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy : a metaanalysis. Obstet Gynecol. 2010;116:402–14.CrossRef
11.
Zurück zum Zitat Roberge S, Villa P, Nicolaides K, et al. Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: a systematic review and meta-analysis. Fetal Diagn Ther. 2012;31:141–6.CrossRef Roberge S, Villa P, Nicolaides K, et al. Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: a systematic review and meta-analysis. Fetal Diagn Ther. 2012;31:141–6.CrossRef
12.
Zurück zum Zitat Caron N, Rivard GE, Michon N, et al. Low dose ASA response using the PFA-100 in women with high risk pregnancy. J Obstet Gynecol Can. 2009;31(11):1022–7.CrossRef Caron N, Rivard GE, Michon N, et al. Low dose ASA response using the PFA-100 in women with high risk pregnancy. J Obstet Gynecol Can. 2009;31(11):1022–7.CrossRef
13.
Zurück zum Zitat Rey E, Rivard GE. Is testing for aspirin response worthwhile in high risk pregnancy? Eur J Obstet Gynecol Reprod Biol. 2011;157(1):38–42.CrossRef Rey E, Rivard GE. Is testing for aspirin response worthwhile in high risk pregnancy? Eur J Obstet Gynecol Reprod Biol. 2011;157(1):38–42.CrossRef
14.
Zurück zum Zitat Norgard M, Puho E, Czeizel AE, et al. Aspirin use during early pregnancy and risk of congenital abnormalities: a population based case control study. Am J Obstet Gynecol. 2005;192(3):922–3.CrossRef Norgard M, Puho E, Czeizel AE, et al. Aspirin use during early pregnancy and risk of congenital abnormalities: a population based case control study. Am J Obstet Gynecol. 2005;192(3):922–3.CrossRef
15.
Zurück zum Zitat Poon LC, Syngelaki A, Akolekar R, et al. Combined screening for preeclampsia and small for gestational age at 11–13 weeks. Fetal Diagn Ther. 2013;33:16–27.CrossRef Poon LC, Syngelaki A, Akolekar R, et al. Combined screening for preeclampsia and small for gestational age at 11–13 weeks. Fetal Diagn Ther. 2013;33:16–27.CrossRef
16.
Zurück zum Zitat Gorman N, Wright D, Syngelaki A, et al. Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11–13 weeks gestation. Am J Obstet Gynecol. 2016;214(1):103. Gorman N, Wright D, Syngelaki A, et al. Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11–13 weeks gestation. Am J Obstet Gynecol. 2016;214(1):103.
17.
Zurück zum Zitat Roberge S, Nicolaides K, Demers S, et al. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol. 2017;216(2):110–20.CrossRef Roberge S, Nicolaides K, Demers S, et al. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol. 2017;216(2):110–20.CrossRef
18.
Zurück zum Zitat Wright D, Akolekar R, Syngelaki A, et al. A competing risks model in early screening for preeclampsia. Fetal Diagn Ther. 2012;32:171–8.CrossRef Wright D, Akolekar R, Syngelaki A, et al. A competing risks model in early screening for preeclampsia. Fetal Diagn Ther. 2012;32:171–8.CrossRef
19.
Zurück zum Zitat Rolnik DL, Wright D, Poon LC, et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med. 2017;377(7):613–22.CrossRef Rolnik DL, Wright D, Poon LC, et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med. 2017;377(7):613–22.CrossRef
20.
Zurück zum Zitat Kuc S, Wortelboer EJ, Rijn BB, et al. Evaluation of 7 serum biomarkers and uterine artery doppler ultrasound for first-trimester prediction of preeclampsia: a systematic review. Obstet Gynecol Surv. 2011;66(4):225–39.CrossRef Kuc S, Wortelboer EJ, Rijn BB, et al. Evaluation of 7 serum biomarkers and uterine artery doppler ultrasound for first-trimester prediction of preeclampsia: a systematic review. Obstet Gynecol Surv. 2011;66(4):225–39.CrossRef
21.
Zurück zum Zitat Ebrashy A, Ibrahim M, Marzook A, et al. Usefulness of aspirin therapy in high-risk pregnant women with abnormal uterine artery doppler ultrasound at 14–16 weeks pregnancy: randomized controlled clinical trial. Croat Med J. 2005;46(5):826–31.PubMed Ebrashy A, Ibrahim M, Marzook A, et al. Usefulness of aspirin therapy in high-risk pregnant women with abnormal uterine artery doppler ultrasound at 14–16 weeks pregnancy: randomized controlled clinical trial. Croat Med J. 2005;46(5):826–31.PubMed
22.
Zurück zum Zitat Poon LCY, Nikos A, Kametas NA, et al. Mean arterial pressure at 110 to 136 weeks in the prediction of preeclampsia. Hypertension. 2008;51:1027–33.CrossRef Poon LCY, Nikos A, Kametas NA, et al. Mean arterial pressure at 110 to 136 weeks in the prediction of preeclampsia. Hypertension. 2008;51:1027–33.CrossRef
Metadaten
Titel
Pilot Interventional Study Comparing Fetomaternal Outcomes of 150 mg Versus 75 mg Aspirin Starting Between 11 and 14 Weeks of Pregnancy in Patients with High Risk of Preeclampsia: A Randomized Control Trial
verfasst von
Namrata Kumar
Vinita Das
Anjoo Agarwal
Amita Pandey
Smriti Agrawal
Amrita Singh
Publikationsdatum
20.09.2019
Verlag
Springer India
Erschienen in
The Journal of Obstetrics and Gynecology of India / Ausgabe 1/2020
Print ISSN: 0971-9202
Elektronische ISSN: 0975-6434
DOI
https://doi.org/10.1007/s13224-019-01277-5

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