The International Federation of Gynecology and Obstetrics (<scp>FIGO</scp>) initiative on pre‐eclampsia: A pragmatic guide for first‐trimester screening and prevention

Poon, Liona C.; Shennan, Andrew; Hyett, Jonathan; Kapur, Anil; Hadar, Eran; Divakar, Hema; McAuliffe, Fionnuala M.; Costa, Fabrício da Silva; Dadelszen, Peter von; McIntyre, H. David; Kihara, Anne Beatrice; Renzo, Gian Carlo Di; Romero, Roberto; D’Alton, Mary E.; Berghella, Vincenzo; Nicolaides, Kypros H.; Hod, Moshe

doi:10.1002/ijgo.12802

Cited by 682 publications

(710 citation statements)

References 226 publications

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“…(27) This approach for the prevention of preterm preeclampsia has now been endorsed by the International Federation of Gynecology and Obstetrics (FIGO). (23) However, the effect of aspirin on the enhancement of physiologic transformation in the spiral arteries of the placental bed is still questionable and unproven. Previous studies have demonstrated that uterine artery Doppler resistance index at 24-28 weeks' gestation is not significantly different between women who receive and do not receive low-dose aspirin starting in the first trimester of pregnancy, (10,(87)(88)(89) suggesting that the aspirin effect in preventing preeclampsia might be related to its action on platelets, rather than placental development.…”

Section: Resultsmentioning

confidence: 99%

“…(7,8) In obstetrics, low-dose aspirin has been shown to be effective in preventing preterm preeclampsia, with delivery at <37 weeks' gestation, in women at risk. (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) The ASPRE (27) The latest systematic review and meta-analysis demonstrated that the reduction in the rate of preterm preeclampsia was confined to the subgroup in which aspirin was initiated at ≤16 weeks' gestation and at a daily dose of ≥100 mg (relative risk [RR], 0.33; 95% CI, 0.19-0.57). (20) Evidence suggests that pre-conception or early administration of low-dose aspirin might improve endometrial growth, placental vascularization and organogenesis.…”

Section: Introductionmentioning

confidence: 99%

“…Low-dose aspirin initiated at <11 weeks' gestation was associated with a nonsignificant reduction in the risk of preeclampsia (RR 0.52; 95% CI: 0 23. 1.17, P=0.115), gestational hypertension (RR 0.49; 95% CI: 0.20-1.21; P=0.121) and any hypertensive disorders in pregnancy (RR 0.59; 95% CI 0.33-1.04, P=0.067).…”

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confidence: 99%

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Does low-dose aspirin initiated before 11 weeks’ gestation reduce the rate of preeclampsia?

Chaemsaithong

Cuenca-Gomez

Plana

et al. 2020

American Journal of Obstetrics and Gynecology

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Condensation: Aspirin given at <11 weeks' gestation in high risk women does not reduce the risk of preeclampsia and gestational hypertension but may reduce the risk of preterm delivery. Short title: Early aspirin administration and preeclampsia PROSPERO registration number: CRD42019125006 AJOG at a Glance: Why was this study conducted? • To perform a systematic review and meta-analysis to evaluate the effect of lowdose aspirin initiated at <11 weeks' gestation on the risk of preeclampsia, gestational hypertension, or any hypertensive disorder of pregnancy. Secondary outcomes included preterm delivery at <37 weeks' gestation and fetal growth restriction. Key findings • The administration of low-dose aspirin at <11 weeks' gestation in women with a history of recurrent pregnancy loss, women who had undergone in vitro fertilization or women with thrombophilia or antiphospholipid syndrome was associated with a non-significant decrease in the risk of preeclampsia, gestational hypertension, and any hypertensive disorder of pregnancy. • Early low-dose aspirin reduced the risk of preterm delivery but had no impact on the risk of fetal growth restriction. • Except for preterm delivery and any hypertensive disorder of pregnancy, sensitivity analysis demonstrated similar observations; confirming the robustness of our analysis. What does this add to what is known? • Administration of low-dose aspirin at <11 weeks' gestation to high risk women does not reduce the risk of preeclampsia, gestational hypertension, any hypertensive disorder of pregnancy and fetal growth restriction but might reduce the risk of preterm delivery at <37 weeks of gestation. ABSTRACT OBJECTIVE DATA: Pre-conception or early administration of low-dose aspirin might improve endometrial growth, placental vascularization and organogenesis. Most studies have evaluated the potential benefit of pre-conception or early administration of low-dose aspirin in women with a history of recurrent pregnancy loss, women who have undergone in vitro fertilization or women with thrombophilia or antiphospholipid syndrome. These women are at an increased risk of placenta-associated complications of pregnancy, including preeclampsia, preterm delivery and fetal growth restriction. STUDY: We performed a systematic review and meta-analysis to evaluate the effect of low-dose aspirin initiated at <11 weeks' gestation on the risk of preeclampsia, gestational hypertension, or any hypertensive disorder of pregnancy. Secondary outcomes included preterm delivery at <37 weeks' gestation and fetal growth restriction. STUDY APPRAISAL AND SYNTHESIS METHODS: We searched in MEDLINE via PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.Gov and the World Health Organization International Clinical Trials Registry Platform (WHO-ICTRP) from 1985 to November 2018. Entry criteria were randomized controlled trials evaluating the effect of aspirin administered at <11 weeks' gestation in preventing preeclampsia and/or hypertensive disorders in pregnancy or improvi...

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Does low-dose aspirin initiated before 11 weeks’ gestation reduce the rate of preeclampsia?

Chaemsaithong

Cuenca-Gomez

Plana

et al. 2020

American Journal of Obstetrics and Gynecology

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“…that well‐designed prospective studies of predictive markers and randomized intervention studies are necessary to develop and validate new prediction models before their introduction into clinical practice, we strongly disagree that these have yet to be performed. In the last three decades, many well‐designed prospective studies involving tens of thousands of patients have established all the necessary requirements for effective clinical implementation of routine screening for PE. We present here some of the evidence generated by our group; however, many other researchers have contributed through their data to the following conclusions.…”

mentioning

confidence: 89%

Re: Prediction of pre‐eclampsia: review of reviews

Nicolaides

Wright

2019

Ultrasound in Obstet & Gyne

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“…Although non-pharmacological treatments have always been considered marginal in the management of hypertension in pregnancy, their role should be taken into account in light of the most recent evidence. As a matter of fact, randomized controlled clinical trials testing the efficacy and safety of dietary supplements in pregnancy are numerous compared to conventional drugs, and their results seem to be promising [6]. For this reason, their use in clinical practice should be encouraged [7].…”

Section: Introductionmentioning

confidence: 99%

Nutraceuticals and Hypertensive Disorders in Pregnancy: The Available Clinical Evidence

Fogacci

Cicero

2020

Nutrients

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The aim of the present critical review is to summarize the available clinical evidence supporting the use of some dietary supplements that have been shown to lower blood pressure in hypertensive pregnant women. A systematic search strategy was carried out to identify trials in MEDLINE (National Library of Medicine, Bethesda, Maryland, MD, USA; January 1980 to September 2019) and the Cochrane Register of Controlled Trials (The Cochrane Collaboration, Oxford, UK). The terms ‘nutraceuticals’, ‘dietary supplements’, ‘pregnancy’, ‘pre-eclampsia’, ‘clinical trial’, and ‘human’ were incorporated into an electronic search strategy. The references of the identified studies and review articles were reviewed to look for additional studies of interest. We preferably selected papers that reported recent comprehensive reviews or meta-analysis, or original clinical trials of substances with blood pressure-lowering or vascular protective effect in pregnancy. There is a relative body of evidence that supports the use of calcium, vitamin D, folic acid, and resveratrol in preventing the development of hypertensive disorders in pregnancy, and evidence supporting drug treatment too. Further clinical research is advisable to identify the dosage and timing of the supplementation, the group of women that might benefit the most from this approach, and the nutraceuticals with the best cost-effectiveness and risk-benefit ratio for widespread use in clinical practice.

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The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre‐eclampsia: A pragmatic guide for first‐trimester screening and prevention

Cited by 682 publications

References 226 publications

Does low-dose aspirin initiated before 11 weeks’ gestation reduce the rate of preeclampsia?

Does low-dose aspirin initiated before 11 weeks’ gestation reduce the rate of preeclampsia?

Re: Prediction of pre‐eclampsia: review of reviews

Nutraceuticals and Hypertensive Disorders in Pregnancy: The Available Clinical Evidence

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