Low dose aspirin for preventing fetal growth restriction: a randomised trial

Abstract

The purpose of this study was to investigate when in pregnancy to stop the administration of low dose aspirin (150 mg/daily) so as to prevent fetal growth restriction (FGR) A randomised, placebo-controlled study was designed. The patients were all screened positive using the Fetal Medicine Foundation (FMF) early pregnancy screening test for preeclampsia (PE) and FGR prediction. One hundred and fifty patients were enrolled and divided equally into three groups: A – the controls who received placebo treatment; B – those who received aspirin till 32 weeks of gestation and C – those who received aspirin till 36 weeks of gestation. The mean gestational age at enrollment was similar for all the groups (12.4 weeks). The growth curves, fetal and maternal Doppler measurements and amniotic fluid index (AFI) were monitored every 4 weeks. Also, the outcome of the pregnancy was noted and all the results were compared between the groups. FGR was defined as a fetal weight below the 10th centile for gestational age. In group C, there were less cases of FGR compared with the other groups: 6% vs. 10% in group B vs. 24% in controls. Also, there was a significant birth weight improvement in this group with a median of 3180 g compared with 2950 g in group B and 2760 g in group A (P=0.01). The gestational age at delivery was similar in all the groups (39 weeks in group C/39.2 weeks in group B/38.6 weeks in group A). In conclusion, low dose aspirin improves the outcome in the selected population and should be offered for prevention of FGR from 12 to 36 weeks.

Aspirin for the prevention of preterm and term preeclampsia: systematic review and metaanalysis

“…The inclusion criteria were met in 16 studies for a total of 18,907 participants. 7,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Thirty of the studies were excluded because data for preterm preeclampsia were not provided by the authors. Details of individual studies are given in the Appendix.…”

“…The quality of the included studies is shown in Figure 2; 8 studies were evaluated as being of good quality, 7,[17][18][19][20][21][22][23] and the other 8 studies were considered to be of poor or uncertain quality. 16,[24][25][26][27][28][29][30] There was high heterogeneity within studies (I 2 >50%) for preterm and term preeclampsia, but no heterogeneity was found in the subgroup of preterm preeclampsia when the onset of treatment was 16 weeks of gestation and the daily dose of aspirin was 100 mg (I 2 ¼0%). Publication bias cannot be excluded based on the analysis of the funnel plot (Figure 3).…”

Variation in outcome reporting in randomized controlled trials of interventions for prevention and treatment of fetal growth restriction

“…Seventy‐two reports from 68 trials met the inclusion criteria and were included in the systematic review (Figure ). Forty‐four trials reported on potential interventions for the prevention of FGR and 24 (29 studies) reported on interventions for the treatment of pregnancies affected by FGR. Five papers reporting outcomes from the DIGITAT trial and two from the TRUFFLE trial were included.…”

Does Pentaerytrithyltetranitrate reduce fetal growth restriction in pregnancies complicated by uterine mal-perfusion? Study protocol of the PETN-study: a randomized controlled multicenter-trial

“…Enormous studies have been undertaken to reveal the usefulness of low-dose aspirin (LDA) or antioxidants for secondary and primary prevention of FGR [6, 7]. Although LDA is effective for primary prevention, if initiated before 16 weeks gestation [8, 9], there is still no treatment option for those recognized beyond 20 weeks.…”