Center for Fetal Therapy, Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.
Ultrasound Obstet Gynecol. 2018 Dec;52(6):728-733. doi: 10.1002/uog.18992. Epub 2018 Nov 9.
To study women who initiated aspirin in the first trimester for high risk of pre-eclampsia, and compare blood-pressure trends throughout pregnancy between those with normal outcome and those who subsequently developed pre-eclampsia.
Women were enrolled into a prospective observational study at 9-14 weeks' gestation. This was a secondary analysis of those who started daily doses of 81 mg of aspirin before 16 weeks for increased risk of pre-eclampsia based on maternal history and bilateral uterine artery notching. Enrollment characteristics and blood-pressure measurements throughout gestation were compared between women who did and those who did not develop pre-eclampsia.
Of the 237 women who initiated first-trimester aspirin prophylaxis, 29 (12.2%) developed pre-eclampsia. A total of 2881 serial blood-pressure measurements obtained between 4 and 41 weeks' gestation (747 in the first trimester, 1008 in the second and 1126 in the third) showed that women with pre-eclampsia started pregnancy with higher blood pressure and maintained this trend despite taking aspirin (mean arterial blood pressure in women with pre-eclampsia = (0.13 × gestational age (weeks)) + 93.63, vs (0.11 × gestational age (weeks)) + 82.61 in those without; P < 0.005). First-trimester diastolic and second-trimester systolic blood pressure were independent risk factors for pre-eclampsia (β = 1.087 and 1.050, respectively; r = 0.24, P < 0.0001). When average first-trimester diastolic blood pressure was >74 mmHg, the odds ratio for pre-eclampsia was 6.5 (95% CI, 2.8-15.1; P < 0.001) and that for pre-eclampsia before 34 weeks was 14.6 (95% CI, 1.72-123.5; P = 0.004). If, in addition, average second-trimester systolic blood pressure was >125 mmHg, the odds ratio for pre-eclampsia was 9.4 (95% CI, 4.1-22.4; P < 0.001) and that for early-onset disease was 34.6 (95% CI, 4.1-296.4; P = 0.004).
In women treated with prophylactic aspirin from the first trimester, those who develop pre-eclampsia have significantly and sustained higher blood pressure from the onset of pregnancy compared with those who do not develop pre-eclampsia. This raises the possibility that mildly elevated blood pressure predisposes women to abnormal placentation, which then acts synergistically with elevated blood pressure to predispose such women to pre-eclampsia to a degree that is incompletely mitigated by aspirin. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
研究在妊娠早期开始使用阿司匹林预防子痫前期高危的女性，并比较血压在整个妊娠期间的趋势，比较正常结局组和随后发生子痫前期组之间的血压趋势。
在妊娠 9-14 周时，将女性纳入前瞻性观察性研究。这是一项基于病史和双侧子宫动脉切迹对子痫前期风险增加而在 16 周前开始每日 81mg 阿司匹林预防的女性的二次分析。比较发生子痫前期和未发生子痫前期的女性在整个妊娠期间的入组特征和血压测量值。
在 237 例开始妊娠早期阿司匹林预防的女性中，29 例（12.2%）发生子痫前期。在妊娠 4-41 周之间共获得 2881 次连续血压测量值（第 1 孕期 747 次，第 2 孕期 1008 次，第 3 孕期 1126 次），显示发生子痫前期的女性在妊娠开始时血压较高，尽管服用了阿司匹林，但仍保持这种趋势（子痫前期患者的平均动脉压为（0.13×妊娠周数（周））+93.63，而无子痫前期患者为（0.11×妊娠周数（周））+82.61；P<0.005）。第 1 孕期舒张压和第 2 孕期收缩压是子痫前期的独立危险因素（β=1.087 和 1.050，r=0.24，P<0.0001）。当第 1 孕期平均舒张压>74mmHg 时，子痫前期的比值比为 6.5（95%CI，2.8-15.1；P<0.001），而在 34 周前发生子痫前期的比值比为 14.6（95%CI，1.72-123.5；P=0.004）。如果第 2 孕期平均收缩压也>125mmHg，子痫前期的比值比为 9.4（95%CI，4.1-22.4；P<0.001），而早发型疾病的比值比为 34.6（95%CI，4.1-296.4；P=0.004）。
在妊娠早期开始预防性使用阿司匹林的女性中，与未发生子痫前期的女性相比，发生子痫前期的女性从妊娠开始时血压明显且持续升高。这提示轻度升高的血压可能使女性更容易发生胎盘异常，然后与升高的血压协同作用，使女性发生子痫前期的风险增加，而这种风险不能被阿司匹林完全缓解。版权所有 © 2017 ISUOG。由 John Wiley & Sons Ltd 出版。
