Fetal Medicine Research Institute, King's College London, London, UK.
School of Population Health and Environmental Sciences, King's College London, London, UK.
BJOG. 2020 Jul;127(8):1018-1025. doi: 10.1111/1471-0528.16193. Epub 2020 Mar 25.
To compare maternal haemodynamics in women at low and high risk for preterm pre-eclampsia (PE), and between those at high risk who are randomised to aspirin or placebo.
Prospective, longitudinal observational study.
Maternity units in six UK hospitals.
Women participating in the Aspirin for Prevention of Preterm Pre-eclampsia (ASPRE) trial. The population comprised three groups of women: low risk for preterm PE (n = 1362), high risk for preterm PE treated with aspirin (n = 208) and high risk for preterm PE on placebo (n = 220).
Women had four visits during pregnancy: 11-14, 19-24, 30-34, and 35-37 weeks' gestation. Blood pressure was measured with a device validated for pregnancy, and PE and maternal haemodynamics were assessed with a bioreactance monitor at each visit. A multilevel linear mixed-effects analysis was performed to examine longitudinal changes of maternal haemodynamic variables, controlling for demographic characteristics, past medical history and medication use.
Longitudinal changes of cardiac output (CO), mean arterial pressure (MAP), and peripheral vascular resistance (PVR).
The low-risk group demonstrated the expected changes with an increase in CO and reduction in MAP and PVR, with a quadratic change across gestation. In contrast, the high-risk groups had a declining CO, and higher MAP and PVR during pregnancy. The administration of aspirin did not appear to affect maternal haemodynamics.
Women screened as high risk for preterm PE have a pathological cardiac adaptation to pregnancy and the prophylactic use of aspirin (150 mg oral daily from the first trimester) in this group may not alter this haemodynamic profile.
In women at high risk of pre-eclampsia, prophylactic use of aspirin may not alter the impaired maternal cardiac adaptation.
比较低危和高危早产先兆子痫（PE）孕妇的母体血液动力学，以及高危孕妇随机分配至阿司匹林组或安慰剂组之间的差异。
前瞻性、纵向观察性研究。
英国六家医院的产科病房。
参与阿司匹林预防早产先兆子痫（ASPRE）试验的孕妇。该人群包括三组孕妇：低危早产 PE 组（n=1362）、高危早产 PE 用阿司匹林治疗组（n=208）和高危早产 PE 用安慰剂组（n=220）。
孕妇在妊娠期间接受四次访视：11-14、19-24、30-34 和 35-37 孕周。使用经过妊娠验证的设备测量血压，并在每次访视时使用生物电阻抗监测仪评估 PE 和母体血液动力学。采用多级线性混合效应分析来检测母体血液动力学变量的纵向变化，同时控制人口统计学特征、既往病史和药物使用情况。
心输出量（CO）、平均动脉压（MAP）和外周血管阻力（PVR）的纵向变化。
低危组表现出预期的变化，CO 增加，MAP 和 PVR 降低，整个妊娠过程呈二次变化。相比之下，高危组在妊娠期间 CO 下降，MAP 和 PVR 升高。阿司匹林的给药似乎并未影响母体血液动力学。
筛查为高危早产 PE 的女性对妊娠有病理心脏适应性，该组预防性使用阿司匹林（从孕早期开始每日口服 150mg）可能不会改变这种血液动力学特征。
在有早产先兆子痫风险的女性中，预防性使用阿司匹林可能不会改变受损的母体心脏适应性。
