Maternal low molecular weight heparin versus sildenafil citrate for fetal growth restriction: a randomized, parallel groups, open-label clinical trial

Rasheedy, Radwa; Bishry, G El; Tarek, R

doi:10.1038/s41372-019-0544-1

Cited by 5 publications

(11 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A previous study reported that LMWH use decreased the incidence of NICU admission (44.0%) among pregnant women with placenta‐mediated FGR 25 . Our study further supported this finding with a much lower incidence (23.3%).…”

Section: Discussionsupporting

confidence: 89%

“…A study showed that LMWH use was associated with improvement in umbilical blood flow and neonatal birth weight among women with FGR. 25 In the present study, we added that LMWH use was associated with a significantly lower risk of intrauterine fetal death among pregnant women with placentamediated FGR, which is important for pregnant women and family members. To our knowledge, this is the first study to explore the association between LMWH and intrauterine fetal death among pregnant women with placenta-mediated FGR.…”

Section: Discussionmentioning

confidence: 75%

See 1 more Smart Citation

Effect of low‐molecular‐weight heparin on placenta‐mediated fetal growth restriction in a tertiary referral hospital: A 7‐year retrospective cohort study

Xu,

Tang,

Peng

et al. 2023

Intl J Gynecology & Obste

View full text Add to dashboard Cite

ObjectiveTo investigate the effect of low‐molecular‐weight heparin (LMWH) on placenta‐mediated fetal growth restriction (FGR).MethodsA cohort of 570 pregnant women diagnosed with placenta‐mediated FGR were enrolled from January 1, 2015 through to December 31, 2021. A birth database, including demographic data, antenatal complications, and detailed delivery and newborn data, was created to collect variables from the Hospital Information System (HIS) Database. The unique personal registration number, assigned to each patient on first registration with HIS in the West China Second University Hospital, was used to link these patients. LMWH use was defined as at least 1‐week prescription from diagnosis of placenta‐mediated FGR. Pregnant women received LMWH (Enoxaparin 4000 IU/day) by self‐administered subcutaneous injection only when they agreed and signed informed consent. Primary outcome was intrauterine fetal death after 20 weeks of pregnancy. Secondary outcomes included preterm birth (PB), Apgar score less than 7 at 1 min, admission to neonatal intensive care unit (NICU), and birth weight. Logistic regression analysis was conducted to compute adjusted odds ratio (aOR) with 95% confidence intervals (CI) for outcomes.ResultsAfter controlling for confounders, LMWH use was associated with a decreased risk of intrauterine fetal death (aOR 2.49, 95% CI 1.35–4.57, P = 0.003), PB before 37 weeks of pregnancy (aOR 3.35, 95% CI 2.14–5.23, P < 0.001), PB before 34 weeks of pregnancy (aOR 2.25, 95% CI 1.36–3.74, P = 0.002), Apgar score less than 7 at 1 min (aOR 2.25, 95% CI 1.36–3.74, P = 0.002), NICU admission (aOR 2.29, 95% CI 1.48–3.55, P < 0.001). Using LMWH increased the mean birth weight in PB before 32 weeks of pregnancy (mean ± standard deviation [SD] 1126.4 ± 520.0 g, P = 0.020), PB before 37 weeks of pregnancy (mean ± SD 1563.9 ± 502.7 g, P = 0.019), early‐onset FGR (mean ± SD 2125.2 ± 665.7 g, P < 0.001), late‐onset FGR (mean ± SD 2343.4 ± 507.9, P < 0.001), and non‐severe FGR (mean ± SD 2231.1 ± 607.2 g, P < 0.001).ConclusionUse of LMWH can significantly improve the fetal and neonatal outcomes among pregnant women with placenta‐mediated FGR, particularly reducing the risk of intrauterine fetal death.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 75%

Effect of low‐molecular‐weight heparin on placenta‐mediated fetal growth restriction in a tertiary referral hospital: A 7‐year retrospective cohort study

Xu,

Tang,

Peng

et al. 2023

Intl J Gynecology & Obste

View full text Add to dashboard Cite

show abstract

“…Of these 86 manuscripts, 68 papers were excluded for a variety of reasons. A further three studies [27][28][29] were excluded, as retraction notices 30,31 had been issued by the relevant journals and a further five [32][33][34][35][36] were excluded following data-integrity assessment (Table S2). Sensitivity analysis of outcomes with inclusion of these excluded studies is presented in Table S4.…”

Section: R E Su Ltsmentioning

confidence: 99%

Phosphodiesterase‐5 inhibitors in pregnancy: Systematic review and meta‐analysis of maternal and perinatal safety and clinical outcomes

Turner

Russo

Deprest

et al. 2022

BJOG

View full text Add to dashboard Cite

Background:The efficacy and safety profile of phosphodiesterase-5 inhibitors (PDE-5i) in pregnancy are unclear from the few relatively small diverse studies that have used them.Objective: To assess the safety profile and clinical outcomes of PDE-5i use in pregnancy. Search strategy:We searched Embase, PubMed, CENTRAL, Prospero and Google Scholar to identify randomised controlled trials (RCTs) reporting the use of any PDE-5i in pregnancy up to September 2021.Selection criteria: RCTs reporting obstetric or perinatal outcomes or maternal adverse outcomes in women taking PDE5i in pregnancy. Data collection and analysis:Risk ratios (RR), 95% confidence intervals (95% CI) and 95% prediction intervals were calculated and pooled for analysis. Results:We identified 1324 citations, of which 10 studies including 1090 participants met the inclusion criteria. Only tadalafil and sildenafil were reported as used in pregnancy. Two studies using tadalafil and eight sildenafil. Nine of ten studies were assessed at having of low risk of bias. PDE-5i use was associated with an increased risk of headaches (RR 1.41, 95% CI 0.97-2.05), flushing (RR 2.59, 95% CI 0.69-9.90) and nasal bleeding (RR 10.53,); an increase in vaginal birth when used for nonfetal growth restriction (FGR) indications (RR 1.24, 95% CI 1.00-1.55) and a reduction in risk of operative birth for intrapartum fetal compromise (RR 0.58, 95% CI 0.38-0.88). There was no evidence of any increase in risk of perinatal death (RR 0.89, 95% CI 0.56-1.43). However, use for the treatment of FGR increased the risk of persistent pulmonary hypertension of the newborn (PPHN) (RR 2.52, 95% CI 1.00-6.32). Conclusions:This meta-analysis suggests PDE-5i use in pregnancy is associated with mild maternal side effects and lower risk of operative birth for intrapartum fetal distress. Prolonged use for the treatment of FGR may increase the risk of PPHN.

show abstract

“…10 On the other hand, a recent study found LMWH to be superior to sildenafil citrate for outcomes of birth weight, time from randomisation to delivery and fetoplacental blood flow indices, for pregnant women with placentally mediated fetal growth restriction. 11 This case report outlines the progress of a 23-year-old female with TAO who was managed in pregnancy with aspirin and enoxaparin. Although her ischaemic symptoms remained stable throughout pregnancy, her case was complicated by placental malperfusion and resultant IUGR.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Thromboangiitis obliterans in pregnancy – Case report and literature review

Farquhar

Lamprecht

2021

Obstet Med

View full text Add to dashboard Cite

Thromboangiitis obliterans, also known as Buerger’s disease, is rarely reported in young women in pregnancy. It is an occlusive vascular disorder, characterised by episodic non-atherosclerotic thrombosis of small- and medium-sized blood vessels. Thromboangiitis obliterans predominantly occurs in males aged less than 50 years and is almost exclusively diagnosed in smokers. The small number of published cases have frequently reported worsening of thrombotic symptoms, due to the hypercoagulable state of pregnancy, and potential pregnancy complications of intra-uterine growth restriction and pre-term labour. This report provides a summary of the literature and outlines the case of a pregnant 23-year-old female with thromboangiitis obliterans, who was managed with low-dose enoxaparin and aspirin. Her thrombotic symptoms were stable during pregnancy; however, her pregnancy was complicated by placental malperfusion and intra-uterine growth restriction.

show abstract

Maternal low molecular weight heparin versus sildenafil citrate for fetal growth restriction: a randomized, parallel groups, open-label clinical trial

Cited by 5 publications

References 63 publications

Effect of low‐molecular‐weight heparin on placenta‐mediated fetal growth restriction in a tertiary referral hospital: A 7‐year retrospective cohort study

Effect of low‐molecular‐weight heparin on placenta‐mediated fetal growth restriction in a tertiary referral hospital: A 7‐year retrospective cohort study

Phosphodiesterase‐5 inhibitors in pregnancy: Systematic review and meta‐analysis of maternal and perinatal safety and clinical outcomes

Thromboangiitis obliterans in pregnancy – Case report and literature review

Contact Info

Product

Resources

About