Maternal Fetal Medicine Division, Obstetrics and Gynecology Department, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
Obstetrics and Gynecology Department, Flushing Hospital Medical Center, Flushing, NY.
Am J Obstet Gynecol. 2020 Sep;223(3):419.e1-419.e16. doi: 10.1016/j.ajog.2020.03.004. Epub 2020 Mar 12.
Patients with chronic hypertension are at increased risk for superimposed preeclampsia. The 2016 American College of Obstetricians and Gynecologists guideline recommended initiating 81 mg of daily aspirin for all pregnant women with chronic hypertension to prevent superimposed preeclampsia.
(1) To evaluate the rates of implementation of the 2016 American College of Obstetricians and Gynecologists guideline over time; and (2) to evaluate the effectiveness of aspirin for the prevention of superimposed preeclampsia and other adverse maternal and neonatal outcomes in women with chronic hypertension before and after this guideline.
This is a retrospective study of women with chronic hypertension who delivered at Thomas Jefferson University Hospital from January 2014 through June 2018. This cohort of women with chronic hypertension was divided into 2 groups, before and after the American College of Obstetricians and Gynecologists recommendation published in September 2016. Daily 81 mg of aspirin was initiated between 12 and 16 weeks. We excluded multiple gestations and incomplete records. The primary outcome was incidence of superimposed preeclampsia, and secondary outcomes were incidence of superimposed preeclampsia with or without severe features, small for gestational age, and preterm birth <37 weeks. Subgroup analysis based on risk stratification was evaluated in women with chronic hypertension requiring antihypertensive medication, history of preeclampsia, and pregestational diabetes.
We identified 457 pregnant women with chronic hypertension, 203 in the post-American College of Obstetricians and Gynecologists group and 254 in the pre-American College of Obstetricians and Gynecologists group. Aspirin 81 mg was offered to 142 (70%) in the post-American College of Obstetricians and Gynecologists group and 18 (7.0%) in the pre-American College of Obstetricians and Gynecologists group. Maternal demographics were not significantly different. The overall incidence of superimposed preeclampsia was not significantly different: 87 (34.3%) vs 72 (35.5%), P=.79, in the pre- and post-American College of Obstetricians and Gynecologists guideline groups, respectively. Superimposed preeclampsia with severe features significantly increased: 32 (12.6%) vs 9 (4.4%), P<.01, whereas superimposed preeclampsia without severe features significantly decreased: 55 (21.7%) vs 63 (31.0%), P=.03. There were no significant differences in small for gestational age neonates or preterm birth <37 weeks incidences between groups. There were no significant differences in the subgroup analysis based on the severity of chronic hypertension requiring antihypertensive medication, history of preeclampsia, or pregestational diabetes.
After the adoption of the American College of Obstetricians and Gynecologists guidelines in 70% of the cohort, superimposed preeclampsia, small for gestational age, and preterm birth were not significantly decreased after implementation of aspirin 81 mg initiated between 12 and 16 weeks of gestation.
患有慢性高血压的患者发生子痫前期的风险增加。2016 年美国妇产科医师学会指南建议所有患有慢性高血压的孕妇每日服用 81mg 阿司匹林，以预防子痫前期的发生。
（1）评估 2016 年美国妇产科医师学会指南的实施率随时间的变化；（2）评估阿司匹林预防慢性高血压孕妇子痫前期及其他不良母婴结局的有效性，比较该指南发布前后的效果。
这是一项回顾性研究，纳入了 2014 年 1 月至 2018 年 6 月在托马斯杰斐逊大学医院分娩的慢性高血压孕妇。将患有慢性高血压的孕妇分为两组，一组在 2016 年 9 月美国妇产科医师学会发布建议之前，另一组在之后。两组孕妇均在 12-16 周时开始服用 81mg 的阿司匹林。我们排除了多胎妊娠和记录不完整的孕妇。主要结局是子痫前期的发生率，次要结局是子痫前期合并或不合并严重特征、小于胎龄儿和早产（<37 周）的发生率。根据需要降压药物治疗、子痫前期病史和孕前糖尿病对慢性高血压孕妇进行风险分层，评估亚组分析。
我们共纳入了 457 例慢性高血压孕妇，其中 203 例在接受美国妇产科医师学会建议之后，254 例在之前。在接受美国妇产科医师学会建议之后的组中，142 例（70%）接受了 81mg 阿司匹林治疗，而在之前的组中，18 例（7.0%）接受了该治疗。两组的产妇人口统计学特征无显著差异。子痫前期的总体发生率无显著差异：分别为 34.3%（87/254）和 35.5%（80/229），P=0.79。子痫前期合并严重特征的发生率显著增加：分别为 12.6%（32/254）和 4.4%（10/229），P<.01，而子痫前期不合并严重特征的发生率显著降低：分别为 21.7%（55/254）和 31.0%（70/229），P=0.03。两组在小于胎龄儿或早产（<37 周）的发生率方面无显著差异。基于需要降压药物治疗的慢性高血压严重程度、子痫前期病史或孕前糖尿病的亚组分析也无显著差异。
在该队列中 70%的孕妇采用美国妇产科医师学会指南后，在 12-16 周开始服用 81mg 阿司匹林，子痫前期、小于胎龄儿和早产的发生率并未显著降低。
