Long Shangqin, Zhang Liren, Li Xiaodong, He Yongjie, Wen Xin, Xu Nannan, Li Xiaoqing, Wang Jingmin
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Department of Obstetrics and Gynecology, Dalian City Third People's Hospital, Dalian, China.
Front Pediatr. 2023 May 5;11:1148547. doi: 10.3389/fped.2023.1148547. eCollection 2023.
Positive antiphospholipid antibodies (aPLs) and chronic hypertension (CH) in pregnancy are important causes of maternal and neonatal morbidity and mortality. However, there are no relevant studies on the treatment of aPL-positive pregnant women with CH. This study aimed to determine the effect of low-dose aspirin (LDA) plus low-molecular-weight heparin (LMWH) on maternal and perinatal outcomes in persistently aPL-positive pregnant women with CH.
This study was performed at the First Affiliated Hospital of Dalian Medical University in Liaoning, China, from January 2018 to December 2021. Pregnant women diagnosed CH and persistently positive aPL who had no autoimmune disease such as systemic lupus erythematosus, antiphospholipid syndrome were recruited and divided into control group (LDA and LWMH were not used), LDA group (LDA was used) and LDA plus LMWH group (both LDA and LMWH were used) according to whether they use LDA and/or LMWH. A total of 81 patients were enrolled, including 40 patients in the control group, 19 patients in the LDA group, and 22 patients in the LDA plus LMWH group. The maternal and perinatal outcomes of LDA plus LMWH therapy were analysed.
Compared with control group, the rate of severe preeclampsia in LDA group (65.00% vs. 31.58%, = 0.016) and LDA plus LMWH group (65.00% vs. 36.36%, = 0.030) had a statistically significant reduction. Compared with control group, the rate of fetal loss in LDA group (35.00% vs. 10.53%, = 0.014) and LDA plus LMWH group (35.00% vs. 0.00%, = 0.002) had a statistically significant reduction. Compared with control group, the rate of live birth in LDA group (65.00% vs. 89.74%, = 0.048) and LDA plus LMWH group (65.00% vs. 100.00%, = 0.002) had a statistically significant increased. Compared withcontrol group, the incidence of early-onset preeclampsia (47.50% vs. 36.84%, = 0.008) and early-onset severe preeclampsia (47.50% vs. 13.64%, = 0.001) in the LDA plus LMWH group decreased and were statistically different. Furthermore, we also found that LDA or LDA plus LMWH hadn't increase the rate of blood loss and placental abruption.
Both LDA and LDA combined with LMWH could decrease the incidence of severe preeclampsia, decrease the rate of foetal loss, increase the rate of live birth. However, LDA plus LWMH could reduce and delay the onset of severe preeclampsia, prolong the gestational age and increase the rate of full-term delivery, improve the maternal and perinatal outcomes.
妊娠期间抗磷脂抗体（aPL）阳性和慢性高血压（CH）是孕产妇和新生儿发病及死亡的重要原因。然而，目前尚无关于CH合并aPL阳性孕妇治疗的相关研究。本研究旨在确定低剂量阿司匹林（LDA）联合低分子量肝素（LMWH）对CH合并aPL持续阳性孕妇的母婴及围产结局的影响。
本研究于2018年1月至2021年12月在辽宁省大连医科大学附属第一医院进行。招募诊断为CH且aPL持续阳性、无自身免疫性疾病（如系统性红斑狼疮、抗磷脂综合征）的孕妇，根据是否使用LDA和/或LMWH分为对照组（未使用LDA和LMWH）、LDA组（使用LDA）和LDA联合LMWH组（同时使用LDA和LMWH）。共纳入81例患者，其中对照组40例，LDA组19例，LDA联合LMWH组22例。分析LDA联合LMWH治疗的母婴及围产结局。
与对照组相比，LDA组（65.00% 对31.58%，P = 0.016）和LDA联合LMWH组（65.00% 对36.36%，P = 0.030）的重度子痫前期发生率有统计学意义的降低。与对照组相比，LDA组（35.00% 对10.53%，P = 0.014）和LDA联合LMWH组（35.00% 对0.00%，P = 0.002）的胎儿丢失率有统计学意义的降低。与对照组相比，LDA组（65.00% 对89.74%，P = 0.048）和LDA联合LMWH组（65.00% 对100.00%，P = 0.002）的活产率有统计学意义的提高。与对照组相比，LDA联合LMWH组的早发型子痫前期（47.50% 对36.84%，P = 0.008）和早发型重度子痫前期（47.50% 对13.64%，P = 0.001）发生率降低且有统计学差异。此外，我们还发现LDA或LDA联合LMWH并未增加失血率和胎盘早剥率。
LDA以及LDA联合LMWH均可降低重度子痫前期的发生率，降低胎儿丢失率，提高活产率。然而，LDA联合LMWH可减少并延迟重度子痫前期的发生，延长孕周，提高足月分娩率，改善母婴及围产结局。
