孕早期低剂量阿司匹林补充剂对低风险妊娠孕早期功能参数的影响。

Impact of early supplementation with low-dose aspirin on functional first trimester parameters in low-risk pregnancies.

作者信息

Zvanca Mona Elena, Bot Mihaela, Radu Dan, Radu Nicoleta, Petca Aida

机构信息

a Department of Obstetrics and Gynaecology , Carol Davila University of Medicine and Pharmacy, Elias University Hospital , Bucharest , Romania.

出版信息

J Matern Fetal Neonatal Med. 2019 Feb;32(4):604-609. doi: 10.1080/14767058.2017.1387532. Epub 2017 Oct 16.

DOI:10.1080/14767058.2017.1387532

PMID:28974130

Abstract

INTRODUCTION

There is recent evidence that prophylaxis with 150 mg of aspirin given before 14-16 weeks significantly reduces preeclampsia rates and may improve pregnancy outcome. We conducted an observational study that investigates the effect of low-dose aspirin initiated early in pregnancy or in preconception on functional parameters assessed at 11-14 weeks.

MATERIALS AND METHODS

We have retrospectively selected 128 pregnant women that presented for the first trimester screening for aneuploidies between 11 and 13 weeks of gestation and received low-dose aspirin before 14 weeks. We excluded cases with an estimated high risk for early preeclampsia (cut-off > 1:100). This group was matched to 1044 cases that did not receive aspirin in early pregnancy. We have selected for statistical analysis maternal parameters, ultrasound parameters (crown-rump length, nuchal translucency thickness, pulsatility index in uterine arteries - left, right, average and average uterine PI expressed in multiple of median (MoM)), first trimester maternal biochemical markers (free β hCG and PAPP-A expressed in MoM), and the calculated risk for early onset and late onset preeclampsia.

RESULTS

The most common dosages of aspirin were 75 mg (77 cases) and 100 mg (32 cases). The most significant results are within the aspirin group. In the subgroup that received aspirin before 11 weeks (110 cases), irrespective of the dosage, the uterine blood flow is significantly improved (average uterine PI 1.7 compared with 2.22, p < .05, (0.24-0.7) 95% CI) and the PAPP-A levels are higher (1.2 compared with 0.82, p > .05, [(-0.65) - 0.02] 95% CI). The estimated risk for both early and late onset preeclampsia in this group is reduced (1:2141 compared with 1:333 for early preeclampsia, p < .05, (1216-2398) 95% CI; 1:361 compared with 1:99 for late onset preeclampsia, p < .05, (173-351) 95% CI).

CONCLUSION

Even though the results are not always statistically significant, they demonstrate that placentation parameters improve with higher doses of aspirin started before 11 weeks.

摘要

引言

最近有证据表明，在孕14 - 16周前服用150毫克阿司匹林进行预防可显著降低先兆子痫的发生率，并可能改善妊娠结局。我们进行了一项观察性研究，以调查在妊娠早期或孕前开始使用低剂量阿司匹林对孕11 - 14周时评估的功能参数的影响。

材料与方法

我们回顾性选择了128例在妊娠11至13周进行早期非整倍体筛查且在孕14周前接受低剂量阿司匹林治疗的孕妇。我们排除了早期先兆子痫估计高风险的病例（截断值>1:100）。该组与1044例在妊娠早期未接受阿司匹林治疗的病例进行匹配。我们选择了母体参数、超声参数（头臀长度、颈项透明层厚度、子宫动脉搏动指数——左、右、平均，以及以中位数倍数（MoM）表示的平均子宫PI）、孕早期母体生化标志物（以MoM表示的游离β - hCG和PAPP - A）以及早期和晚期先兆子痫的计算风险进行统计分析。

结果

阿司匹林最常用的剂量为75毫克（77例）和100毫克（32例）。最显著的结果出现在阿司匹林组内。在孕11周前接受阿司匹林治疗的亚组（110例）中，无论剂量如何，子宫血流均显著改善（平均子宫PI为1.7，而未用药组为2.22，p <.05，（0.24 - 0.7）95%CI），且PAPP - A水平更高（1.2，而未用药组为0.82，p >.05，[(-0.65)−0.02]95%CI）。该组早期和晚期先兆子痫的估计风险均降低（早期先兆子痫为1:2141，而未用药组为1:333，p <.05，（1216 - 2398）95%CI；晚期先兆子痫为1:361，而未用药组为1:99，p <.05，（173 - 351）95%CI）。