Randomized, Controlled Trial Using Low-Dose Aspirin in the Prevention of Preeclampsia in Women With Abnormal Uterine Artery Doppler at 23 Weeks Gestation

Abstract

Although heavy alcohol use over an extended time is known to impair fetal growth, the effects, if any, of light or moderate consumption are not clear. This study examined drinking patterns on term small-for-gestational-age (SGA) births, with particular attention to binge drinking in the 3 months before pregnancy and the last 3 months of pregnancy. Data on 50,461 women who delivered singleton full-term infants (37-42 weeks gestation) were obtained from the Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Questionnaires were mailed 2 to 6 months after delivery, and nonrespondents were interviewed by phone. The study population was predominantly white, 18 to 34 years of age, had 12 or more years of education, was married, and did not smoke in late pregnancy. Light drinkers took 3 or fewer drinks in an average week, whereas moderate consumption was defined as 4 to 13 drinks and heavy drinking as 14 or more drinks per week on average. Binging was defined as taking 5 or more drinks in one sitting. Close to half the women reported drinking just before pregnancy, 94% of them at a light level. In the last trimester, fewer than 1% of all women and 18% of heavy drinkers binged. SGA births were more common in moderate or heavy prepregnancy drinkers than in light drinkers or nondrinkers. No such association was evident, however, for drinking in the last trimester. Although women who binged at either time were not significantly likelier to deliver an SGA infant, those binging in late pregnancy were 20% more likely to do so. After adjusting for confounding variables, women who were light or moderate drinkers before pregnancy were somewhat less likely to deliver an SGA infant, although the difference was not significant. Women who drank lightly or moderately in late pregnancy were not prone to have an SGA birth. At all levels of alcohol use the risk of an SGA birth was greater for bingers, but this was significant only for heavy drinkers. The lower risk of SGA birth found in some women who drink might be related to vascular effects of alcohol, or to dietary differences between women who drink before pregnancy or in late pregnancy and those who do not. A prospective study would clarify the observations made in this population of parturients. ABSTRACTVaginal bleeding in early pregnancy could be mistaken for menstruation, and it could lead to errors in estimating gestational age, especially in pregnancies that end in miscarriage. This prospective study examined patterns of vaginal bleeding in 151 healthy women whose pregnancies lasted at least 6 weeks beyond the last menstrual period (LMP). The participants collected daily urine samples that were assayed for human chorionic gonadotropin and kept a diary of vaginal bleeding as well as sexual intercourse. Early vaginal bleeding was defined as bleeding lasting a day or longer between conception and follow up, which extended through week 8 after the LMP in nearly all cases. Early vaginal bleeding was described by 9% of women. Typically, it was light and required only 1 or 2 ...

Comparison between the roles of low-dose aspirin and folic acid in preventing preeclampsia among high-risk women screened by uterine artery Doppler at 22–24 weeks of gestation

“…Our results are also not in agreement with those of Yu et al [22], who randomized 560 pregnant women at 23 weeks with uterine artery pulsatility index more than 1.6 to receive either aspirin 150 mg/day or a placebo. They excluded patients with chronic hypertension or pregestational diabetes from the study.…”

“…They excluded patients with chronic hypertension or pregestational diabetes from the study. They found no significant differences between the aspirin (18.7%) and the placebo groups (17.8%) in the incidence of preeclampsia (P = 0.77) [22].…”

Correlation between the Doppler velocimetry findings of the uterine arteries during the first and second trimesters of pregnancy

“…However randomized studies testing prophylactic interventions, such as low-dose aspirin to reduce such complications in patients identified as high-risk, based on mid-second trimester uterine artery Doppler findings, have not proven effective 3,14 . Perhaps these interventions are being tested at a gestational age too far ahead in the trophoblastic invasion process.…”

“…Several treatments have been proposed to reduce the incidence of such complications during pregnancy. However randomized studies evaluating interventions, such as low dose daily aspirin for women identified as high-risk, based on second trimester Doppler findings, have not shown a significant reduction in the rate of these complications 3 .…”

Predição da pré-eclâmpsia pelo estudo dopplervelocimétrico endovaginal das artérias uterinas entre 11-13 e 20-24 semanas de gestação

“…As propostas incluem, desde medidas como menor periodicidade entre as consultas, até a administração de substâncias profiláticas, como aspirina em baixas dosagens, suplementação com ácidos graxos, cálcio, zinco, magnésio ou vitaminas antioxidantes (18,82) . Entretanto, estudos prospectivos randomizados, em populações selecionadas, com base em critérios dopplervelocimétricos, não mostraram efeitos benéficos até o presente momento (83,84) . Possivelmente, a instituição de medidas profiláticas, no segundo trimestre da gestação, seja tarde demais para alterar a história natural da pré-eclâmpsia, pois um outro estudo de menor escala demonstrou efeito benéfico da aspirina, em baixas doses, quando administrada à população selecionada entre 12 e 14 semanas de gestação (85) .…”