This paper is only available as a PDF. To read, Please Download here.
Abstract
Low-dose aspirin (50 to 150 mg) improves the imbalance between prostacyclin and thromboxane which is observed in proteinuric pre-eclamsia and intra-uterine growth restriction. The stratification of the published clinical trials according to the maternal and fetal risk level suggests that this drug may be effective in preventing proteinurie pre-eclampsia and intra-uterine growth restriction only in women at high risk for these complications. However, low-dose aspirin does not reduce the incidence of pregnancy-induced hypertension and perinatal mortality, and does not influence the clinical course of established pre-eclampsia. The drug should be begun before 28 weeks of pregnancy and could be taken until delivery. Low-dose aspirin is safe for the mother and the newborn infant.
Résumé
L’aspirine à faible dose (50 à 150 mg) corrige le déséquilibre entre la prostacycline et le thromboxane qui existe dans la pré-éclampsie et le retard de croissance intra-utérin. L’analyse des études cliniques en fonction du niveau de risque suggère que l’aspirine à faible dose prévient la pré-éclampsie avec protéinurie et le retard de croissance intra-utérin uniquement chez les femmes ayant un risque élevé de présenter ces complications. Par contre, elle ne diminue pas l’incidence d’hypertension artérielle induite par la grossesse sans protéinurie et la mortalité périnatale et ne modifie pas l’évolution clinique de la pré-éclampsie. L’aspirine doit être commencée avant 28 semaines et peut être prise jusqu’à l’accouchement. L’aspirine à faible dose semble sans danger pour la mère et le nouveau-né.
Key Words
References
- The risks and benefits of taking aspirin during pregnancy.Epidemiol Rev. 1990; 12: 108-148
- Low-dose aspirin to pregnant women: single dose pharmacokinetics and influence of short term treatment on bleeding ti me.J Perinat Med. 1994; 22: 205-211
- Differentiai inhibition of prostacyclin production and platelet aggregation by aspirin.Lancet. 1979; 2: 1213-1217
- Differentiai inhibition of prostaglandin endoperoxide synthase (cyclooxygenase) isozymes by aspirin and ether nonsteroidal anti-inflammatory drugs.J Biol Chem. 1993; 268: 6610-6614
- Low-dose aspirin in pregnancy.Obstet Gynecol. 1989; 74: 551-557
- Prevention of recurrent idiopathie fetal growth retardation by low-dose aspirin and dipyridamole.Am J Obstet Gynecol. 1987; 157: 1230-1235
- et coll. The use of aspirin to prevent pregnancy-induced hypertension and lower the ratio of thromboxane A2 to prostacyclin in relatively high risk pregnancies.N Engl J Med. 1989; 321: 351-356
- Low dose aspirin in hypertensive pregnant women: effect on pregnancy outcome and prostacyclin-thromboxane balance in mother and newborn.Br J Obstet Gynaecol. 1993; 100: 809-815
- Caritis SN, Thom E, Shaw K, McNellis D, and the Nationale lnstitute of Child Health and Human Development Maternai-Fetal Medicine Network. Low-dose aspirin in nulliparous women: safety of continuous epidural block and correlation between bleeding time and maternal-neonatal bleeding complications.Am J Obstet Gynecol. 1995; 172: 1553-1557
- et coll. Neonatal platelet reactivity and serum thromboxane B2 production in whole blood: the effect of maternallow dose aspirin.Br J Obstet Gynaecol. 1994; 101: 203-208
- et coll. Effect of lowdose aspirin on fetal and maternai generation of thromboxane by plate lets in women at risk for pregnancy-induced hypertension.N Engl J Med. 1989; 321: 357-362
- Downing 1. Prostacyclin in pregnancy.Br Med J. 1980; 280: 1581-1582
- Prostacyclin production during pregnancy: comparaison of production during normal pregnancy and pregnancy complicated by hypertension.Am J Obstet Gynecol. 1982; 142: 817-822
- Placental prostacyclin production in normal and toxemie pregnancies.Am J Obstet Gynecol. 1985; 151: 110-115
- et coll. Decreased prostacyclin production: a characteristic of chronic placental insufficiency syndrome.Lancet. 1981; 1: 1126-1128
- The analysis of multidimensional contigency tables: stepwise procedures and direct estimation methods for building models for multiple classifications.Technometrics. 1971; 13: 33-61
- Antiplatelet agents for IUGR and pre-eclampsia.in: Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP (eds.) Pregnancy and chilbirth module of the Cochrane data base of systemactic reviews 1995 [updated 24 february. 1995
- ECPPA: randomised trial of low dose aspirin for the prevention of maternal and fetal complications in high risk pregnant women.Br J Obstet Gynaecol. 1996; 103: 39-47
- et coll. Prevention of preeclampsia with low-dose aspirin in healthy, nulliparous women.N Engl J Med. 1993; 329: 1213-1218
- CLASP: a randomized trial of low-dose aspirin for the prevention and treatment of preeclampsia among 9364 pregnant women.Lancet. 1994; 343: 619-629
- et coll. Low-dose aspirin therapy to prevent preeclampsia.Am J Obstet Gynecol. 1993; 168: 1083-1091
- Low-dose aspirin in prevention and treatment of intrauterine growth retardatien and pregnancy-induced hypertension.Lancet. 1993; 341: 396-400
- Prevention of pre-eclampsia by early antiplatelet therapy.Lancet. 1985; 1: 840-842
- Low-dose aspirin prevents pregnancy-induced hypertension and pre-eclampsia in angiotensin-sensitive primigravidae.Lancet. 1986; 1: 1-3
- Doppler ultrasound and aspirin in recognition and prevention of pregnancy-induced hypertension.Lancet. 1990; 335: 1552-1555
- Prevention of fetal growth retardation with low-dose aspirin: findings of the EPREDA trial.Lancet. 1991; 337: 1427-1431
- et coll. Low-dose aspirin in primigravidae with positive roll-over test.Gynecol Obstet Invest. 1992; 34: 146-150
- Prevention of pregnancy-induced hypertension in twins by early administration of low-dose aspirin: a preliminary report.Am J Reprod Immunol. 1994; 31: 19-24
- The angiotensin sensitivity test and low-dose aspirin are ineffective methods to predict and prevent hypertensive disorders in nulliparous pregnancy.Am J Obstet Gynecol. 1995; 173: 865-872
- Low dose aspirin in women with raised maternai serum alpha-fetoprotein and abnormal Doppler waveform patterns from the uteroplacental circulation.Br J Obstet Gynaecol. 1994; 101: 481-484
- A randomized controlled trial of aspirin in patients with abnormal uterine artery blood flow.Obstet Gynecol. 1996; 87: 74-78
- Low-dose aspirin therapy improves fetal weight in umbilical placental insufficiency.Am J Obstet Gynecol. 1988; 159: 681-685
- Low-dose aspirin does not influence the clinical course of women with mild pregnancy-induced hypertension.Obstet Gynecol. 1990; 76: 742-744
- Swedish Aspirin Lowdose Trial (SALn of 75 mg aspirin as secondary prophylaxis after cerebrovascular ischaemic events.Lancet. 1991; 338: 1345-1349
- Extracranial bleeding and other symptoms due to low dose aspirin and low intensity oral anticoagulation.Thromb Haemost. 1992; 68: 1-6
- Cardiac function in fetuses and newborns exposed to low-dose aspirin during pregnancy.Am J Obstet Gynecol. 1994; 171: 892-900
- A clinical trial of a slow-release formulation of acetylsalicylic acid in patients at risk for preeclampsia.Br J Clin Pharmacol. 1993; 35: 664-667
Article info
Publication history
Accepted:
April 21,
1996
Received in revised form:
April 21,
1996
Received:
March 8,
1996
Identification
Copyright
© 1996 Published by Elsevier Inc.
