Role of Aspirin in High Pulsatility Index of Uterine Artery: A Consort Study

Sharma, Nidhi; Srinivasan, Sunayana; Srinivasan, Krishnamurthy Jayashree; Nadhamuni, Kulasekaran

doi:10.1007/s13224-017-1058-4

Cited by 6 publications

(3 citation statements)

References 34 publications

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“…Acetylsalicylic is an anti-inflammatory medication that could decrease resistance in the uteroplacental blood flow by inhibiting thromboxane-mediated vasoconstriction and permitting prostacyclin-mediated vasodilation. 17 18 Recently, The Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Pre-eclampsia Prevention (ASPRE) trial reported that ASA at a dose of 150 mg per day, started between 11 and 14 weeks, reduces the incidence of preterm PE by 62% in patients with a high risk of developing PE, 19 but a meta-analysis aimed at assessing the impact of the start of ASA intake at the 2 nd trimester in women with abnormal UtA-PI showed no benefit regarding the reduction of PE, suggesting that its action is lost after week 16. 20 Currently, there are not enough data to explain how the mean UtA-PI behaves as the gestation progresses when women take ASA before 14 weeks and it has not been explored whether ASA could modify the 95 th percentile of mean UtA-PI when patients with high risk of PE at the 2 nd and 3 rd trimesters are followed-up.…”

Section: Introductionmentioning

confidence: 99%

Could Aspirin Treatment Modify the Assessment of the Uterine Arteries?

Vallejo

Uriel

Porras-Ramírez

et al. 2022

Rev Bras Ginecol Obstet

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Objective To analyze whether acetylsalicylic (ASA) intake modifies the mean uterine arteries pulsatility index (UtA-PI) at the 2nd or 3rd trimester in a cohort of pregnant women with abnormal mean UtA-PI at between 11 and 14 weeks of gestation. Methods This is a retrospective cohort study. Singleton pregnancies with abnormal mean UtA-PI at between 11 and 14 weeks of gestation were studied. The participants were divided into 3 groups: 1) If the participant did not take ASA during pregnancy; 2) If the participant took ASA before 14 weeks of gestation; and 3) If the participant took ASA after 14 weeks of gestation. The mean UtA-PI was evaluated at the 2nd and 3rd trimesters, and it was considered to improve when it decreased below the 95th percentile. The prevalence ratio (PR) and the number needed to treat (NNT) were calculated. Results A total of 72 participants with a mean UtA-PI > 95th percentile at the 1st trimester of gestation were evaluated. Out of the 18 participants who took ASA, 8 participants started it before 14 weeks of gestation and 10 after. A total of 33.3% of these participants had improved the mean UtA-PI at the 2nd and 3rd trimesters of gestation, although it was not statistically significant (p = 0.154). The prevalence ratio was 0.95 (95% confidence interval [CI]: 0.31–1.89), but between the 1st and 2nd trimesters of gestation, the PR was 0.92 (95%CI: 0.21–0.99) and it was statistically significant. Conclusion The present work demonstrates a modification of the mean UtA-PI in participants who took ASA compared with those who did not. It is important to check if ASA can modify the normal limits of uterine arteries because this could have an impact on surveillance.

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Section: Introductionmentioning

confidence: 99%

Could Aspirin Treatment Modify the Assessment of the Uterine Arteries?

Vallejo

Uriel

Porras-Ramírez

et al. 2022

Rev Bras Ginecol Obstet

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“…The first wave of trophoblast migration occurs at 10 to 14 weeks; the second wave of trophoblast migration in the deep myometrium begins by 18 to 20 weeks and is completed only by 22 to 24 weeks. [24] Nonetheless, some studies have indicated that aspirin started in the late second and third trimester could also prevent eclampsia. [40,41] The American College of Obstetricians and Gynecologists recommends low-dose aspirin (81 mg/d) for prevention from 12 to 28 weeks of gestation until delivery.…”

Section: Discussionmentioning

confidence: 99%

“…[23] There is a positive association between maternal BMI and fetal weight. [24] Obesity might increase the levels of inflammatory markers. [25] Chronic chorioamnionitis has been associated with preterm stillbirth potentially caused by maternal anti-fetal rejection, which may explain approximately 10% of the effect of obesity on the risk of stillbirth.…”

Section: Risk Factors For Stillbirth In Dipmentioning

confidence: 99%

Clinical analysis of diabetes in pregnancy with stillbirth

et al. 2023

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We analyzed the clinical characteristics of patients with diabetes in pregnancy (DIP) associated with stillbirth and explored strategies to reduce its incidence. We retrospectively analyzed 71 stillbirths associated with DIP (group A) and 150 normal pregnancies (group B) during 2009 to 2018. The incidence of the following was higher in group A (P < .05): hypertensive disorders (38.03% vs 6.00%), placenta previa (14.08% vs 2.67%), placental abruption (5.63% vs 0.67%), fetal malformation (8.45% vs 0.67%), fasting plasma glucose (FPG) ≥ 7.0 mmol/L (46.48% vs 0.67%), 2-h postprandial plasma glucose ≥ 11.1 mmol/L (57.75% vs 6.00%), HbA1c ≥ 6.5% (63.38% vs 6.00%), and polyhydramnios (11.27% vs 4.67). The incidence of oligohydramnios (4.23% vs 6.67%) was lower in group A than in group B (P < .05). According to the gestational age at the time of stillbirth, Group-A cases were subgrouped into miscarriages (20-27 +6 weeks), premature deliveries (28-36 +6 weeks), and full-term deliveries (≥37 weeks). Age, parity, and DIP type did not differ among the subgroups (P > .05). Among patients with DIP, antenatal FPG, 2-h postprandial plasma glucose, and HbA1c were significantly associated with stillbirth (P < .05). Stillbirth was first detected at 22 weeks and typically occurred at 28-36 +6 weeks. DIP was associated with a higher incidence of stillbirth, and FPG, 2-h postprandial plasma glucose, and HbA1c were potential indicators of stillbirth in DIP. Age (odds ratio [OR]: 2.21, 95% confidence interval [CI]: 1.67-2.74), gestational hypertension (OR: 3.44, 95% CI: 2.21-4.67), body mass index (OR: 2.86, 95% CI: 1.95-3.76), preeclampsia (OR: 2.29, 95% CI: 1.45-3.12), and diabetic ketoacidosis (OR: 3.99, 95% CI: 1.22-6.76) were positively correlated with the occurrence of stillbirth in DIP. Controlling perinatal plasma glucose, accurately detecting and managing comorbidities/ complications, and timely termination of pregnancy can reduce the incidence of stillbirths associated with DIP.Abbreviations: BMI = body mass index, CI = confidence interval, DIP = diabetes in pregnancy, FGR = fetal growth restriction, FPG = fasting plasma glucose, GDM = gestational diabetes mellitus, HbA1c = glycohemoglobin, OR = odds ratio, PGDM = pregestational diabetes mellitus.

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Antiplatelet agents for preventing pre-eclampsia and its complications

Duley

Meher

Hunter

et al. 2019

Cochrane Database of Systematic Reviews

196

210

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Aspirin in the prevention of pre-eclampsia in high-risk women* Sir, We thank Dr Thornton for his interest in our article 'Aspirin in the prevention of pre-eclampsia in high-risk women' published in the January 2013 issue of BJOG. 1 He raises four points we would like to respond to: the strength of effect; sample size; exclusion of participants from the main analysis; and trial registration.Dr Thornton concludes the commentary by writing that the effect of aspirin we reported in the meta-analysis for women who also have abnormal uterine artery Doppler waveforms at 14 weeks of gestation differs little from its effect in other high-risk groups. We have difficulty in agreeing with this; in our opinion the risk ratio in our meta-analysis (RR 0.55; 95% CI 0.37-0.83) differs from those reported by the Cochrane review. 2,3 The differences are even better encapsulated by comparing the numbers needed to treat (NNTs). In our meta-analysis, the substantial reduction in risk together with the high initial risk (36%) resulted in an NNT of six for preventing preeclampsia, whereas the Cochrane review reported an NNT for pre-eclampsia of 19 for women at high risk (20% risk) and 119 for women at moderate risk (6%), and concluded that 'further information is required to assess which women are most likely to benefit, when treatment is best started, and at what dose'. The PARIS meta-analysis reported a 10% reduction and an NNT of 56 for women at high risk (18% risk) and 167 for women at moderate risk (6%).In other respects our study represents both the strengths and weaknesses of clinician-initiated trials. With limited funding, from non-commercial sources only, the participating clinicians in ten centres were able to screen 947 women whose history indicated an increased risk of pre-eclampsia, to find those whose uterine artery flow indicates a particularly high risk. As we discuss in the article, in hindsight the criterion chosen was too strict, and only 152 women could be randomised. Although Dr Thornton is correct in stating that 31 of these women discontinued the treatment for various reasons and were excluded from the main analysis, he seems to overlook our description of the intention-to-treat analysis of all randomised women (except those who had a miscarriage), which gave a similar result. We do agree about the shortcomings of the information included in the ISRCTN registration (www.controlled-trials.com/ISRCTN140 30412/), submitted by one member of the study team. For example, variables that were eventually listed in the outcomes section include predictor variables such as biochemical measurements during pregnancy. It should also be noted that the planned number of participants stated on the ISRCTN website, of 1000 women, refers to the women to be screened by Doppler ultrasound, and not those to be eventually randomised, as Dr Thornton stated in his commentary.In our conclusion we echoed the words of the Cochrane review that 'further information is required to assess which women are most likely to benefit', and proposed that...

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Role of Aspirin in High Pulsatility Index of Uterine Artery: A Consort Study

Cited by 6 publications

References 34 publications

Could Aspirin Treatment Modify the Assessment of the Uterine Arteries?

Could Aspirin Treatment Modify the Assessment of the Uterine Arteries?

Clinical analysis of diabetes in pregnancy with stillbirth

Antiplatelet agents for preventing pre-eclampsia and its complications

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