Glycemic Control and Aspirin Resistance in Patients Taking Low-Dose Aspirin for Pre-eclampsia Prevention

Abstract

Objectives To assess the association between aspirin and glycemic control in diabetic, pregnant patients, and the risk for aspirin resistance in those with poor glycemic control across gestation taking low-dose aspirin (LDA) for pre-eclampsia (PEC) prevention. Study Design We performed a secondary analysis of samples collected during the Maternal-Fetal Medicine Units trial of LDA for PEC prevention. A subset of insulin-controlled diabetic patient samples on placebo or 60 mg aspirin daily were evaluated. Glycosylated hemoglobin was measured at randomization, mid-second trimester, and third trimester time points. Thromboxane B2 (TXB2) measurements were previously assessed as part of the original study. Primary outcome was the effect of LDA on glycosylated hemoglobin levels compared with placebo across gestation. Results Levels of glycosylated hemoglobin increased across gestation in the placebo group (2,067.7 [interquartile range, IQR: 1,624.6–2,713.5 µg/mL] vs. 2,461.9 [1,767.0–3,209.9 µg/mL] vs. 3,244.3 [2,691.5–4,187.0 µg/mL]; p < 0.01) compared with no difference in levels of glycosylated hemoglobin across gestation in the LDA group (2,186.4 [IQR: 1,462.3–3,097.7 µg/mL] vs. 2,337.1 [1,327.7–5,932.6 µg/mL] vs. 2,532.9 [1,804.9–5,511.8 µg/mL]; p = 0.78). Higher levels of glycosylated hemoglobin were associated with increased TXB2 levels prior to randomization (r = 0.67, p < 0.05). Incomplete TXB2 was higher in pregnancies with increasing levels of glycosylated hemoglobin compared with those with decreasing levels of glycosylated hemoglobin across gestation (69.2 vs. 18.1%, p = 0.02). Conclusion LDA exposure may be beneficial to glycemic control in this patient population. Additionally, poor glycemic control is associated with a higher level of TXB2 in diabetic pregnant patients on LDA. Higher doses of aspirin may be required in these patients to prevent development of PEC. Key Points

Aspirin protects against preeclampsia via p38MAPK signaling pathway

“…If an abnormal invasion of extravillous trophoblasts occurs, shallow placental implantation and insufficient uterine-placenta perfusion may appear. This will lead to long-term hypoxia and ischemia of the syncytiotrophoblasts, and the release of a large number of inflammatory factors, thereby triggering oxidative stress and vascular endothelial injury [11]. In addition, the secretion of prostaglandin is reduced, while the secretion of thromboxane A2 is enhanced, leading to an imbalance in the ratio of prostaglandin to thromboxane A2, abnormal function, and a hypercoagulable state of the blood.…”

Fetomaternal Outcome in Eclampsia at Tertiary Care Centre: A Descriptive Cross-Sectional Study

“…Any of these symptoms may be present before or after the seizure. 19 The fact that eclampsia is completely preventable significant cause of maternal and fetal morbidity and mortality; this study aims to find out the fetomaternal outcome in eclampsia. The magnitude of effects in terms of complications on the mother and the fetus in this study will alert the obstetrician to take preventive measures against eclampsia and this will benefit both the mother and the fetus.…”