Aspirin for the prevention of preeclampsia: A systematic review and meta-analysis of randomized controlled studies

Investigating the association of albuminuria with the incidence of preeclampsia and its predictive capabilities: a systematic review and meta-analysis

BACKGROUND

Preeclampsia (PE) is a severe hypertensive disorder affecting approximately 6.7% of pregnancies worldwide. Identifying reliable biomarkers for early prediction could significantly reduce the incidence of PE and facilitate closer monitoring and timely management. This study aims to investigate the association between albuminuria in early pregnancy and the subsequent development of PE, and to explore its predictive abilities.

METHODS

A systematic search was conducted across PubMed, Embase, and Web of Science on July 15, 2024, for studies published between January 1, 1990, and June 30, 2024. Quality assessments were performed using the Joanna Briggs Institute Critical Appraisal and Risk of Bias in Non-randomized Studies - of Exposures Checklists. Random-effects models in STATA were used to conduct meta-analyses comparing urine albumin and albumin-to-creatinine ratio levels in patients who later developed PE versus those who did not. The incidence of PE was also compared between patients with and without albuminuria in early pregnancy. The predictive ability of albuminuria for PE was assessed using META-DISC software.

RESULTS

A total of 26 studies comprising 7,640 pregnant women were systematically reviewed. Of these, 17 studies met the quality criteria for inclusion in the meta-analyses. Our findings indicate that urine albumin (Hedges's g = 0.48 [95% confidence interval (CI): 0.16-0.80]; p-value < 0.001) and albumin-to-creatinine ratio (Hedges's g = 0.48 [95% CI: 0.16-0.80]; p-value = 0.003) were significantly higher in the early stages of pregnancy in patients who later developed PE compared to those who did not. The incidence of PE was higher in patients with early-diagnosed albuminuria (log odds ratio = 2.56 [95% CI: 1.75-3.38]; p-value < 0.001). The pooled sensitivity and specificity for albuminuria in predicting PE were 56% [95% CI: 48-64%] and 87% [95% CI: 85-89%], respectively.

CONCLUSIONS

Elevated maternal urine albumin and albumin-to-creatinine ratio in early pregnancy are associated with a higher risk of developing PE. While these biomarkers show promise for early identification of at-risk patients, the relatively low sensitivity suggests that albuminuria alone may not be a robust predictor of PE, which underscores the need for future research in this regard.

TRIAL REGISTRATION

Review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the code CRD42024575772.

Al-Dahwi R, Georgieva E, Karamalakova Y, Nikolova G. Preeclampsia Treatment Aspirin/Clampsilin: Oxidative Stress, sFlt-1/PIGF Soluble Tyrosine Kinase 1, and Placental Growth Factor Monitoring

The present study aimed to investigate and compare oxidative stress biomarkers and antioxidant enzyme activity in the serum of women at risk of developing preeclampsia (PE) to prevent adverse pregnancy outcomes through early intervention. Changes in soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) levels were measured between 11 and 13 gestational weeks (gw.) before the onset of preeclampsia and its associated complications. This study evaluated the feasibility of the sFlt-1/PlGF biomarker ratio in predicting preeclampsia and adverse pregnancy outcomes, with the goal of preventive therapy with acetylsalicylic acid (150 mg daily), with acetylsalicylic acid (75 mg daily) and Clampsilin. For this purpose, the following were evaluated: (1) the levels of reactive oxygen species (ROS) and reactive nitrogen species (RNS) as parameters of oxidative stress; (2) lipid oxidation; (3) antioxidant enzyme activity; and (4) cytokine production. Analysis of the results showed that pregnant women at risk of preeclampsia had significantly higher levels of ROS, lipid oxidation, and superoxide anion radical (•O2-) levels compared to normal pregnancies. In PE, depleted levels of nitric oxide (NO), impaired NO synthase system (NOS), and reduced antioxidant enzyme activity (p < 0.03) suggest that PE patients cannot compensate for oxidative stress (OS). In conclusion, oxidative stress in PE plays a key role, which arises from placental problems and affects both mother and baby. The groups with acetylsalicylic acid therapy (150 mg and 75 mg) were better affected compared to those on Clampsillin.

Role of Systemic Immune-Inflammation Index, Systemic Inflammation Response Index, and Pan-Immune Inflammation Value in the Prediction of Preeclampsia: A Retrospective Cohort Study

OBJECTIVE

The aim of the study was to investigate the role of systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune inflammation value (PIV) calculated from first trimester complete blood count (CBC) in predicting preeclampsia without (PE) and with severe features (PE-SF).

METHODS

This retrospective cohort study included 126 women with PE, 126 women with PE-SF, and 126 women with healthy, normotensive pregnancies delivered at a large tertiary referral hospital between 2018 and 2022. The main outcome measures were SII, SIRI, and PIV.

RESULTS

SII scores differed significantly between the control versus PE and control versus PE-SF groups, while SIRI scores showed a significant difference between the control versus PE and PE versus PE-SF groups. However, the PIV values showed a significant difference in all three groups. According to the receiver operating characteristic analysis performed for the discriminatory power of SII, SIRI, and PIV, the area under the curve (AUC) values were 0.801, 0.609, and 0.774 for the prediction of PE and 0.535, 0.701, and 0751 for the prediction of PE-SF, respectively. An SII with a cutoff value of > 620.59×103/µL (sensitivity 81%, specificity 67%) and an SIRI with a cutoff value of > 0.94×103/µL (sensitivity 74%, specificity 69%) had the highest discriminatory power for the prediction of PE and PE-SF, respectively.

CONCLUSION

Our results suggest an association between high SII, PIV, and SIRI results and an increased risk of future PE and could be used as a first trimester screening test to improve decision making in the prediction of PE.

Kshirsagar N, Patil S. Prediction of pre-eclampsia using gestosis score

Pre-eclampsia (P-EP) is a hypertensive pregnancy (HPT-PG) condition that develops after 20 weeks of gestation, with or without proteinuria and is differentiated by vasospasm and vascular endothelial dysfunction. As a result, it is important to evaluate and predict P-EP using gestosis score (GT-S). We examined 229 pregnant patients at five prenatal visits and P-EP, using the Hypertensive Disease of Pregnancy (HDP) GT-S calculator app and a questionnaire that included 27 risk variables. We discovered a strong association between increased GT-S and the development of P-EP. As a result, GT-S is a reliable predictor of P-EP.

Effect of low-dose aspirin intervention on pre-eclampsia prevention in high-risk pregnant women and its impact on postpartum hemorrhage

Background

Pre-eclampsia, characterized by hypertension and organ dysfunction during pregnancy, poses significant risks to both maternal and fetal health. Aspirin, known for its antiplatelet properties, has been extensively utilized to mitigate pregnancy-related complications. However, the efficacy of low-dose aspirin in managing pre-eclampsia among high-risk pregnant women and its potential impact on postpartum hemorrhage remain contentious topics.

Methods

A retrospective analysis was conducted on 344 pregnant women diagnosed with high-risk factors for pre-eclampsia. Among them, 152 received intervention with low-dose aspirin, while the rest did not receive it. The incidence of pre-eclampsia, as well as related complications and outcomes associated with bleeding, were compared and evaluated between the two groups.

Results

The study findings indicate a significant reduction in the incidence of pre-eclampsia among pregnant women receiving low-dose aspirin intervention, along with a significantly reduced risk of complications. Additionally, there was no significant statistical difference in postpartum hemorrhage between the two groups (p > 0.05). The safety profile of aspirin usage was found to be favorable.

Conclusion

Low-dose aspirin demonstrates promising efficacy as an intervention strategy for high-risk preeclamptic women. It does not increase the risk of postpartum hemorrhage and reduces the occurrence of complications associated with preeclampsia. Therefore, low-dose aspirin presents a potential preventive measure against adverse outcomes associated with high-risk pregnancies related to preeclampsia. Further research is necessary to validate and elucidate the optimal dosage and timing of administration for maximal benefits.

Maternal and Neonatal Outcomes in Pregnant Women With Chronic Hypertension: A Retrospective Study of 50 Cases

Background Chronic hypertension (CHTN) has been associated with significant maternal and neonatal complications. The goal of this research study is to assess outcomes and management strategies among pregnant women living with CHTN. Methods From December 2019 to December 2020, 50 pregnant women diagnosed with CHTN before or at 20 weeks gestation at Cure International Hospital, Kabul, Afghanistan, underwent retrospective analysis using data obtained from patient records, such as demographic details, clinical history notes, laboratory test findings, imaging results, management protocols, and maternal and neonatal outcomes. Results Of the 50 patients, 17 (34%) developed superimposed preeclampsia. Maternal complications included superimposed preeclampsia in 17 (34%), placental abruption in 14 (28%), gestational diabetes in 15 (30%), and acute kidney injury in one (2%). Neonatal complications included preterm birth (12; 24%), low birth weight (12; 24%), small for gestational age (10; 20%), and perinatal mortality (5; 10%). Management strategies revealed that 38 (75%) patients received labetalol, while 12 (25%) were treated with methyldopa. Conclusions CHTN during gestation can result in significant maternal and neonatal complications, and adherence to management guidelines is critical to improve outcomes. More studies are necessary to develop optimal treatment protocols and preventive measures.

Aspirin: latest evidence and developments

Aspirin is a foundation drug of the pharmaceutical industry originally derived as an analgesic/anti-inflammatory agent but serendipitously discovered to have use as a prophylactic drug for major adverse cardiovascular events (MACE). Its modern-day utility in this latter role relies on its efficacy/safety balance in a contemporary population where, at least in high-income countries, age-standardised incident rates for MACE are falling, and where there are now competing therapeutic agents. Its future may be determined by its potential role as a chemoprophylactic or adjunct agent for cancer or other disease states. It therefore will continue to be the subject of further clinical research.

Low-dose aspirin prophylaxis to prevent hypertensive disorders of pregnancy after in vitro fertilisation: a scoping review protocol

INTRODUCTION

Pregnancies resulting from in vitro fertilisation are associated with an increased risk of developing hypertensive disorders of pregnancy, such as preeclampsia, when compared with naturally conceived pregnancies.

OBJECTIVE

The efficacy of aspirin prophylaxis to reduce the incidence of preeclampsia is well established in naturally conceived pregnancies identified as high risk for developing preeclampsia. However, the efficacy of aspirin to reduce the rate of preeclampsia for all pregnancies resulting from in vitro fertilisation remains uncertain, although in vitro fertilisation conception is a well-known risk factor for preeclampsia. Therefore, the purpose of this scoping review is to provide a comprehensive overview of the current literature regarding the use of low-dose aspirin to prevent hypertensive disorders of pregnancy after in vitro fertilisation.

INCLUSION CRITERIA

This review will identify all peer-reviewed published articles including pregnant women who underwent embryo transfer after in vitro fertilisation and were prescribed low-dose aspirin to reduce the risk of hypertensive disorders of pregnancy.

METHODS

We have devised a comprehensive search strategy to systematically identify pertinent studies published from January 2000 until May 2024, within the Medline (PubMed interface), Embase and Scopus databases. The search strategy is based on the keywords 'aspirin,' 'pregnancy-induced hypertension,' and ('in vitro fertilization' OR 'oocyte donation' OR 'embryo transfer' OR 'donor conception'). Two reviewers will independently screen the titles, abstracts and full-text articles to select the relevant articles, using the Covidence software.

ETHICS AND DISSEMINATION

No patients are involved in this study. This study aims to be published in a peer-reviewed journal and could be presented at a conference.

Evaluation of impacts of aspirin therapy versus placebo on preeclampsia: An observational study

Background

Gestational hypertension and pre-eclampsia often increase maternal and neonatal mortality. The illness usually appears after the 20th week of pregnancy due to malnutrition or obesity. Untreated, it can lead to neonatal and maternal mortality. Low-dose Aspirin can prevent preeclampsia if started between 11 and 28 weeks. Several studies support this technique, although others have shown limited effectiveness and negative side effects.

Objective

This study aims to assess the effectiveness of aspirin treatment for the prevention of preeclampsia, taking into account any possible adverse reactions.

Methods

This observational research comprised 600 singleton pregnant women at high risk of pregnancy-induced hypertension. The aspirin group had 301 individuals and the placebo group 299. From 11 to 36 weeks of pregnancy, they received 150 mg of aspirin and 150 mg of placebo. Gestational hypertension was assessed at 25 weeks, 36 weeks, and 37 weeks. If any, aspirin and placebo-related adverse pregnancy and neonatal outcomes were reported.

Results

With aspirin therapy, 4 females and 14 females with placebo developed gestational hypertension before 25 weeks of pregnancy with an odds ratio of 0.283 (0.092-0.87); before 36 weeks, 5 females and 15 females with placebo developed GHD with an odds ratio of 0.331 (0.118-0.922); and after 37 weeks, 17 females and 35 females with placebo developed GHD. Preeclampsia occurred in 5 females in the aspirin group and 17 in the placebo group at <25 weeks (odds ratio 0.292 (0.106-0.802), 7 females in the aspirin arm and 25 females in the placebo arm at <36 weeks (odds ratio 0.278 (0.118-0.652), and 21 females in the aspirin arm and 39 females in the placebo arm at >37 weeks (odds ratio 0.5349 (0.307-0.930).

Conclusion

In pregnant women at high risk of prenatal hypertension and preeclampsia, aspirin therapy is very effective with minimal side effects.