Impact of USPSTF recommendations for aspirin for prevention of recurrent preeclampsia

Tolcher, Mary Catherine; Chu, Derrick M.; Hollier, Lisa M.; Mastrobattista, Joan M.; Racusin, Diana A.; Ramin, Susan M.; Sangi‐Haghpeykar, Haleh; Aagaard, Kjersti M.

doi:10.1016/j.ajog.2017.04.035

Cited by 44 publications

(35 citation statements)

References 41 publications

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“…To date, the only therapeutic option for the prevention of PE is aspirin use. Thus, aspirin given at a daily dose of 75–150 mg from the end of the first trimester to the end of pregnancy may reduce the risk of PE onset by 30% . In women with a history of early onset PE (<34 WG), the gestational time is most often prolonged by approximately five weeks in the subsequent pregnancy .…”

Section: Pathophysiology Of Preeclampsiamentioning

confidence: 99%

Hydroxychloroquine may be beneficial in preeclampsia and recurrent miscarriage

Moreuil

Alavi

Pasquier

2019

Brit J Clinical Pharma

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Recurrent miscarriage (RM) and vasculoplacental disorders, such as preeclampsia (PE), affect women of childbearing age worldwide. Vascular endothelial dysfunction and immunological impairment are associated with both RM and PE. To date, there is no effective or optimal therapeutic approach for these conditions. Notably, aspirin use is only partially effective in the prevention of PE. Hydroxychloroquine (HCQ) has demonstrated beneficial effects on disease flares, pregnancy outcomes and cardiovascular impairment in systemic erythaematosus lupus (SLE) through its immunomodulatory, vasculoprotective and antithrombotic properties. Here, in the context of the underlying physiological dysregulation associated with PE and RM, the beneficial properties and potential therapeutic efficacy of HCQ are reviewed in anticipation of the results of current and future trials. Two related trials addressing RM in the absence of maternal autoimmune disease are ongoing. Other trials addressing pregnancy outcomes in the presence of maternal autoimmune disease are forthcoming. In this review, we hypothesise that the immunological and endothelial effects of HCQ may be beneficial in the context of PE and RM, regardless of the maternal autoimmune status. K E Y W O R D S hydroxychloroquine, pregnancy, preeclampsia, recurrent miscarriage

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Section: Pathophysiology Of Preeclampsiamentioning

confidence: 99%

Hydroxychloroquine may be beneficial in preeclampsia and recurrent miscarriage

Moreuil

Alavi

Pasquier

2019

Brit J Clinical Pharma

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“…From economical perspectives, whether aspirin prophylaxis is for (i) only test‐positive individuals on a formalized screening test algorithm, (ii) only those with major risk factors or (iii) all women without assessment of prior risks remains to be explored . It is advisable to offer aspirin in women with a prior history of pre‐eclampsia because it reduces the recurrence by 30% …”

Section: Resource Implications Of Pre‐eclampsia Prediction and Prophymentioning

confidence: 99%

Prediction and prevention of pre‐eclampsia in Asian subpopulation

Wataganara

Leetheeragul

Pongprasobchai

et al. 2018

J of Obstet and Gynaecol

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The benefit of the early administration of aspirin to reduce preterm pre-eclampsia among screened positive European women from multivariate algorithmic approach (ASPRE trial) has opened an intense debate on the feasibility of universal screening. This review aims to assess the new perspectives in the combined screening of pre-eclampsia in the first trimester of pregnancy and the chances for prevention using low-dose aspirin with special emphasis on the particularities of the Asian population. PubMed, CENTRAL and Embase databases were searched from inception until 15 November 2017 using combinations of the search terms: preeclampsia, Asian, prenatal screening, early prediction, ultrasonography, pregnancy, biomarker, mean arterial pressure, soluble fms-like tyrosine kinase-1, placental growth factor, pregnancy-associated plasma protein-A and pulsatility index. This is not a systematic review or meta-analysis, so the risk of bias of the selected published articles and heterogeneity among the studies need to be considered. The prevalence of pre-eclampsia and serum levels of biochemical markers in Asian are different from Caucasian women; hence, Asian ethnicity needs to be corrected for in the algorithmic assessment of multiple variables to improve the screening performance. Aspirin prophylaxis may still be viable in Asian women, but resource implication needs to be considered. Asian ethnicity should be taken into account before implementing pre-eclampsia screening strategies in the region. The variables included can be mixed and matched to achieve an optimal performance that is appropriate for economical restriction in individual countries.

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“…(7,8) In obstetrics, low-dose aspirin has been shown to be effective in preventing preterm preeclampsia, with delivery at <37 weeks' gestation, in women at risk. (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) The ASPRE (27) The latest systematic review and meta-analysis demonstrated that the reduction in the rate of preterm preeclampsia was confined to the subgroup in which aspirin was initiated at ≤16 weeks' gestation and at a daily dose of ≥100 mg (relative risk [RR], 0.33; 95% CI, 0.19-0.57). (20) Evidence suggests that pre-conception or early administration of low-dose aspirin might improve endometrial growth, placental vascularization and organogenesis.…”

Section: Introductionmentioning

confidence: 99%

“…Publication bias was not assessed due to the small number of included studies. Statistical analysis was performed using Stata release 14.0 (StataCorp, College Station, TX).…”

mentioning

confidence: 99%

Does low-dose aspirin initiated before 11 weeks’ gestation reduce the rate of preeclampsia?

Chaemsaithong

Cuenca-Gomez

Plana

et al. 2020

American Journal of Obstetrics and Gynecology

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Condensation: Aspirin given at <11 weeks' gestation in high risk women does not reduce the risk of preeclampsia and gestational hypertension but may reduce the risk of preterm delivery. Short title: Early aspirin administration and preeclampsia PROSPERO registration number: CRD42019125006 AJOG at a Glance: Why was this study conducted? • To perform a systematic review and meta-analysis to evaluate the effect of lowdose aspirin initiated at <11 weeks' gestation on the risk of preeclampsia, gestational hypertension, or any hypertensive disorder of pregnancy. Secondary outcomes included preterm delivery at <37 weeks' gestation and fetal growth restriction. Key findings • The administration of low-dose aspirin at <11 weeks' gestation in women with a history of recurrent pregnancy loss, women who had undergone in vitro fertilization or women with thrombophilia or antiphospholipid syndrome was associated with a non-significant decrease in the risk of preeclampsia, gestational hypertension, and any hypertensive disorder of pregnancy. • Early low-dose aspirin reduced the risk of preterm delivery but had no impact on the risk of fetal growth restriction. • Except for preterm delivery and any hypertensive disorder of pregnancy, sensitivity analysis demonstrated similar observations; confirming the robustness of our analysis. What does this add to what is known? • Administration of low-dose aspirin at <11 weeks' gestation to high risk women does not reduce the risk of preeclampsia, gestational hypertension, any hypertensive disorder of pregnancy and fetal growth restriction but might reduce the risk of preterm delivery at <37 weeks of gestation. ABSTRACT OBJECTIVE DATA: Pre-conception or early administration of low-dose aspirin might improve endometrial growth, placental vascularization and organogenesis. Most studies have evaluated the potential benefit of pre-conception or early administration of low-dose aspirin in women with a history of recurrent pregnancy loss, women who have undergone in vitro fertilization or women with thrombophilia or antiphospholipid syndrome. These women are at an increased risk of placenta-associated complications of pregnancy, including preeclampsia, preterm delivery and fetal growth restriction. STUDY: We performed a systematic review and meta-analysis to evaluate the effect of low-dose aspirin initiated at <11 weeks' gestation on the risk of preeclampsia, gestational hypertension, or any hypertensive disorder of pregnancy. Secondary outcomes included preterm delivery at <37 weeks' gestation and fetal growth restriction. STUDY APPRAISAL AND SYNTHESIS METHODS: We searched in MEDLINE via PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.Gov and the World Health Organization International Clinical Trials Registry Platform (WHO-ICTRP) from 1985 to November 2018. Entry criteria were randomized controlled trials evaluating the effect of aspirin administered at <11 weeks' gestation in preventing preeclampsia and/or hypertensive disorders in pregnancy or improvi...

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Impact of USPSTF recommendations for aspirin for prevention of recurrent preeclampsia

Cited by 44 publications

References 41 publications

Hydroxychloroquine may be beneficial in preeclampsia and recurrent miscarriage

Hydroxychloroquine may be beneficial in preeclampsia and recurrent miscarriage

Prediction and prevention of pre‐eclampsia in Asian subpopulation

Does low-dose aspirin initiated before 11 weeks’ gestation reduce the rate of preeclampsia?

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