Low-Dose Aspirin Use for the Prevention of Morbidity and Mortality From Preeclampsia: U.S. Preventive Services Task Force Recommendation Statement

Lefevre, Michael

doi:10.7326/m14-1884

Cited by 409 publications

(312 citation statements)

References 14 publications

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“…Baseline assessments of proteinuria and kidney function should be performed before or in early pregnancy in parturients with diabetes to identify those with need for strict antihypertensive control. In addition to aiming at tight glycaemic [33] and BP control [40], low-dose aspirin treatment during pregnancy has been recommended in women with pre-gestational diabetes to reduce the incidence of pre-eclampsia and associated adverse maternal and neonatal outcomes [42,43].…”

Section: Discussionmentioning

confidence: 99%

Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988–2011

et al. 2015

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Aims/hypothesis Our aim was to analyse possible changes in the glycaemic control, BP, markers of renal function, and obstetric and perinatal outcomes of parturients with diabetic nephropathy during 1988-2011. Methods The most recent childbirth of 108 consecutive type 1 diabetes patients with diabetic nephropathy and a singleton pregnancy were studied. Two periods, 1988Two periods, -1999Two periods, and 2000Two periods, -2011 . Antihypertensive medication usage increased before pregnancy (34% vs 65%, p=0.002) and in the second and third trimesters of pregnancy (25% vs 47%, p=0.02, and 36% vs 60%, p =0.01, respectively). BP exceeded 130/ 80 mmHg in 62% and 61% (p=0.87) of patients in the first trimester, and in 95% and 93% (p=0.69) in the third trimester, respectively. No changes were observed in the markers of renal function. Pre-eclampsia (52% vs 42%, p=0.29) and preterm birth rates before 32 and 37 gestational weeks (14% vs 21%, p=0.33, and 71% vs 77%, p=0.49, respectively) remained high. The elective and emergency Caesarean section rates were 71% and 45% (p=0.01) and 29% and 48% (p= 0.05), respectively. Neonatal intensive care unit admissions increased from 26% to 49% (p=0.02). Conclusions/interpretation Early pregnancy glycaemic control and hypertension management were suboptimal in both time periods. Pre-eclampsia and preterm delivery rates remained high in patients with diabetic nephropathy.

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Section: Discussionmentioning

confidence: 99%

Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988–2011

et al. 2015

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“…We calculated incidence reduction of PE and number needed to prevent one case of PE using theoretical preventive interventions with relative risk reductions of 10, 20, and 40%. We also compared the model performance to current guidelines, the NICE and ACOG criteria [35][36][37]. As the ACOG criteria do not specifically define the number of moderate risk factors to identify women at high risk for PE, we defined ≥2 moderate risk factors as high risk [36].…”

Section: Discussionmentioning

confidence: 99%

External Validation and Clinical Usefulness of First Trimester Prediction Models for the Risk of Preeclampsia: A Prospective Cohort Study

et al. 2018

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Introduction: This study assessed the external validity of all published first trimester prediction models for the risk of preeclampsia (PE) based on routinely collected maternal predictors. Moreover, the potential utility of the best-performing models in clinical practice was evaluated. Material and Methods: Ten prediction models were systematically selected from the literature. We performed a multicenter prospective cohort study in the Netherlands between July 1, 2013, and December 31, 2015. Eligible pregnant women completed a web-based questionnaire before 16 weeks’ gestation. The outcome PE was established using postpartum questionnaires and medical records. Predictive performance of each model was assessed by means of discrimination (c-statistic) and a calibration plot. Clinical usefulness was evaluated by means of decision curve analysis and by calculating the potential impact at different risk thresholds. Results: The validation cohort contained 2,614 women of whom 76 developed PE (2.9%). Five models showed moderate discriminative performance with c-statistics ranging from 0.73 to 0.77. Adequate calibration was obtained after refitting. The best models were clinically useful over a small range of predicted probabilities. Discussion: Five of the ten included first trimester prediction models for PE showed moderate predictive performance. The best models may provide more benefit compared to risk selection as used in current guidelines.

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“…Many randomized, controlled trials have been performed without much success. At present, aspirin is recommended and believed to act through antiinflammatory mechanisms [2].…”

Section: Introductionmentioning

confidence: 99%

Pre-eclampsia research in the Norwegian Mother and Child Cohort Study

Magnus¹,

Trogstad²

2014

Nor J Epidemiol

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Pre-eclampsia is a pregnancy disorder of unknown origin. In Norway, pre-eclampsia is reported in 3 to 4 per cent of registered births. At present, November 2014, a series of investigations into the etiology of preeclampsia have been published internationally from the Norwegian Mother and Child Cohort Study (MoBa), and several studies are ongoing. The intention of this paper is to give a short summary of what has been accomplished, and to discuss future avenues of research concerning causes, mechanisms and consequences of pre-eclampsia. The papers that have been published up to now include seven that concern life-styles (physical activity, tobacco and diet), six that include prior pregnancies, infection, gestational weight gain, toxicants and tryptophan metabolism, and two studies concerning issues of selection and validity. Major findings are that tobacco smoking is only associated with reduced risk of pre-eclampsia when it occurs in the last trimester; that processed food and sugar-sweetened beverages are associated with increased risk while vegetables, vitamin D and probiotics are associated with reduced risk; and that prior induced abortions have the same risk-reducing effect as a prior pregnancy. For future studies, we suggest that better use should be made of the family structure built into MoBa. This includes better use of the discordant pregnancy design. A series of ongoing genetic studies, partly in international consortia, will hopefully open new etiological insights. The indications that pre-eclampsia is related to cardiovascular disease and other complex disorders should be further investigated through systematic follow-up of pre-eclamptic women and controls. Finally, MoBa is eminently suited to study the influences that pre-eclampsia can have on the growing child.This is an open access article distributed under the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Low-Dose Aspirin Use for the Prevention of Morbidity and Mortality From Preeclampsia: U.S. Preventive Services Task Force Recommendation Statement

Abstract: The USPSTF recommends the use of low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of gestation in women who are at high risk for preeclampsia. (B recommendation).

Cited by 409 publications

References 14 publications

Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988–2011

Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988–2011

External Validation and Clinical Usefulness of First Trimester Prediction Models for the Risk of Preeclampsia: A Prospective Cohort Study

Pre-eclampsia research in the Norwegian Mother and Child Cohort Study

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