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| GUEST EDITORIAL |
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| Year : 2011 | Volume
: 57
| Issue : 2 | Page : 89-90 |
Prevention of pre-eclampsia with low-dose aspirin
E Bujold
Department of Obstetrics & Gynecology, Faculty of Medicine, Université Laval, Québec, and Centre de Recherche, Centre Hospitalier Universitaire de Québec (CRCHUQ),Québec QC, Canada
| Date of Web Publication | 4-Jun-2011 |
Correspondence Address:
E Bujold
Department of Obstetrics & Gynecology, Faculty of Medicine, Université Laval, Québec, and Centre de Recherche, Centre Hospitalier Universitaire de Québec (CRCHUQ),Québec QC
Canada
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0022-3859.81857
How to cite this article:
Bujold E. Prevention of pre-eclampsia with low-dose aspirin. J Postgrad Med 2011;57:89-90 |
Pre-eclampsia is a pregnancy-specific disease characterized by the development of hypertension and proteinuria, usually after 20 weeks of gestation. Evolution of the disease is very heterogeneous, and it can rapidly progress to multisystem disorders, seizures (eclampsia) and fetal and maternal death when left untreated, with delivery being the only definitive cure. [1] Intra-uterine growth restriction (IUGR) and preterm birth are common and produce associated neonatal morbidities. Therefore, pre-eclampsia remains a major obstetric problem that leads to substantial maternal and perinatal morbidity as well as mortality worldwide, especially in developing countries. Moreover, several studies have suggested that women who develop pre-eclampsia are at increased risk of cardiovascular complications later in life. [2]
Although the cause of pre-eclampsia remains largely unknown, it is characterized by defective placentation that elicits inadequate utero-placental blood perfusion and ischemia, evoking endothelial dysfunction, with platelet aggregation and clotting system activation. The hypothesis that antiplatelet agents, such as low-dose aspirin, might prevent pre-eclampsia has attracted considerable interest since the early 1980s. Whereas early randomized trials were associated with promising findings, subsequent very large trials generated contradictory results and persistent controversy.
The meta-analysis of Prof. Trivedi confirms the results of previous meta-analyses and suggests that low-dose aspirin should not be administered for the prevention of pre-eclampsia in low-risk women. [3],[4] Moreover, its use in high-risk women is associated with modest benefits, such as a 21% reduction in the prevalence of pre-eclampsia. [3] However, the level of risk does not completely explain the heterogeneity between studies and, as Prof. Trivedi emphasized, other factors should be contemplated, including: 1) the dosage and time of day for low-dose aspirin administration; 2) the population investigated; and 3) intervention timing during pregnancy. Recent studies have indicated that 1) low-dose aspirin at bedtime could provide greater benefits and pre-eclampsia prevention than when taken in the morning; [5] 2) up to 30% of women are resistant to low-dose aspirin and platelet aggregation tests could identify them; [6] 3) when started before 16 weeks of gestation, low-dose aspirin could reduce the incidence of severe pre-eclampsia, IUGR and even preterm birth by more than 50%, with almost no heterogeneity between studies. [7],[8] These findings could be explained, at least in part, by the fact that the transformation of uterine spiral arteries by trophoblasts, a physiological phenomenon of human pregnancy that is disordered in pre-eclampsia, is usually completed by 16-20weeks of gestation.
Therefore, future investigations that aim to evaluate the role of low-dose aspirin in the prevention of pre-eclampsia or IUGR should weigh these potentially very important conditions for success. Since several recent studies have indicated that combination of maternal factors with biochemical and/or ultrasound markers could identify women at high-risk of pre-eclampsia as early as the first trimester, a randomized trial, including high-risk nulliparous women, the group that represents the largest proportion of pregnant women at risk of pre-eclampsia, as well as low-dose aspirin at bedtime, should be considered as soon as possible. [9],[10]
| :: References | |  |
| 1. | Magee LA, Helewa M, Moutquin JM, von Dadelszen P. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. SOGC Clinical Practice Guideline No. 206, March 2008. J ObstetGynaecol Can 2008;30(Suppl 1):S1-48. 
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| 2. | Forest JC, Girouard J, Masse J, Moutquin JM, Kharfi A, Ness RB, et al. Early occurrence of metabolic syndrome after hypertension in pregnancy. ObstetGynecol 2005;105:1373-80.
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| 3. | Trivedi NA. A meta-analysis of low-dose aspirin for prevention of preeclampsia. J Postgrad Med 2011;91-5.
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| 4. | Duley L, Henderson-Smart DJ, Meher S, King JF. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev 2007;2:CD004659.
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| 5. | Hermida RC, Ayala DE, Fernández JR, Mojón A, Alonso I, Silva I, et al. Administration time-dependent effects of aspirin in women at differing risk for preeclampsia. Hypertension 1999;34:1016-23.
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| 6. | Caron N, Rivard GE, Michon N, Morin F, Pilon D, Moutquin JM, et al. Low-dose ASA response using the PFA-100 in women with high-risk pregnancy. J ObstetGynaecol Can 2009;31:1022-7.
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| 7. | Bujold E, Morency AM, Roberge S, Lacasse Y, Forest JC, Giguère Y. Acetylsalicylic acid for the prevention of preeclampsia and intra-uterine growth restriction in women with abnormal uterine artery Doppler: A systematic review and meta-analysis. J ObstetGynaecol Can 2009;31:818-26.
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| 8. | Bujold E, Roberge S, Lacasse Y, Bureau M, Audibert F, Marcoux S, et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: A meta-analysis. ObstetGynecol 2010;116:402-14.
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| 9. | Audibert F, Boucoiran I, An N, Aleksandrov N, Delvin E, Bujold E, Rey E. Screening for preeclampsia using first-trimester serum markers and uterine artery Doppler in nulliparous women. Am J ObstetGynecol 2010;203:383.e1-8.
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| 10. | Bujold E, Tapp S, Audibert F, Ferreira E, Forest JC, Rey E, et al. Prevention of adverse pregnancy outcomes with low-dose ASA in early pregnancy: New perspectives for future randomized trials. J Obstet Gynaecol Can 2011;33:480-3.
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| This article has been cited by | | 1 |
Drug Treatment of Hypertension in Pregnancy |
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| Catherine M. Brown,Vesna D. Garovic | | Drugs. 2014; 74(3): 283 | | [Pubmed] | [DOI] | |
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