Lecarpentier E, Haddad B
University Paris Est Créteil and CHI Créteil, Créteil, France; Department of Obstetrics Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, France.
University Paris Est Créteil and CHI Créteil, Créteil, France; Department of Obstetrics Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, France.
J Gynecol Obstet Hum Reprod. 2020 Nov;49(9):101845. doi: 10.1016/j.jogoh.2020.101845. Epub 2020 Jun 25.
Chronic hypertension affects 1-5% of women of childbearing age. During pregnancy, chronic hypertension is associated with an increased risk of vascular disease such as superimposed preeclampsia (PE), intrauterine growth retardation (IUGR), placental abruption, and preterm delivery. These serious and frequent pathologies, specific to pregnancy, carry a particularly high risk of maternal complications (HELLP syndrome, eclampsia, maternal death) and perinatal complications (perinatal death, neurological disorders). To date, there is no curative treatment of vascular complications of chronic hypertension during pregnancy. The only effective treatment, once the complications are established, is usually stopping the pregnancy and delivering the placenta. Some recommendations suggest the use of low dose aspirin in the prevention of these complications. Although the efficacy of low-dose aspirin is assumed in patients with previous preeclampsia, few studies have evaluated its efficacy in patients with chronic hypertension. Controlled prospective studies using very low doses of aspirin (less than 100 mg) and started after 15 weeks of gestation do not seem conclusive. The objective of this work is first to detail the complications of chronic hypertension during pregnancy, then to analyze the studies which evaluated the interest of low dose aspirin in prevention of the placental vascular complications of the pregnancy in patients with chronic hypertension. We also propose an update on the European and North American national recommendations for the prevention of preeclampsia by low dose aspirin in the high-risk population of patients with chronic hypertension. Finally we present the CHASAP (Chronic Hypertension and Acetyl Salicylic Acid in Pregnancy) trial (NCT04356326), a multicentric prospective randomized double-blind superiority trial, which will compare, in pregnant women with chronic hypertension, the efficacy of low dose aspirin (150 mg/day) with a placebo, in the prevention of maternal-fetal morbidity and mortality (preeclampsia, placental abruption, IUGR, perinatal death, maternal death, and preterm delivery).
慢性高血压影响1%至5%的育龄妇女。在孕期，慢性高血压与诸如并发先兆子痫（PE）、胎儿生长受限（IUGR）、胎盘早剥和早产等血管疾病风险增加相关。这些妊娠特有的严重且常见的病症，具有特别高的孕产妇并发症（HELLP综合征、子痫、孕产妇死亡）和围产期并发症（围产期死亡、神经功能障碍）风险。迄今为止，尚无针对孕期慢性高血压血管并发症的治愈性治疗方法。一旦并发症出现，唯一有效的治疗通常是终止妊娠并娩出胎盘。一些建议提出使用低剂量阿司匹林预防这些并发症。尽管低剂量阿司匹林对既往有先兆子痫的患者的疗效已得到认可，但很少有研究评估其对慢性高血压患者的疗效。使用极低剂量阿司匹林（低于100毫克）且在妊娠15周后开始的对照前瞻性研究似乎尚无定论。这项工作的目的首先是详细阐述孕期慢性高血压的并发症，然后分析评估低剂量阿司匹林对预防慢性高血压患者妊娠胎盘血管并发症作用的研究。我们还对欧洲和北美的国家关于在慢性高血压高危人群中使用低剂量阿司匹林预防先兆子痫的建议进行了更新。最后，我们介绍了CHASAP（孕期慢性高血压与乙酰水杨酸）试验（NCT04356326），这是一项多中心前瞻性随机双盲优效性试验，将在慢性高血压孕妇中比较低剂量阿司匹林（150毫克/天）与安慰剂在预防母婴发病和死亡（先兆子痫、胎盘早剥、胎儿生长受限、围产期死亡、孕产妇死亡和早产）方面的疗效。
