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Impact of early supplementation with low-dose aspirin on functional first trimester parameters in low-risk
Mona Elena Zvanca1, Mihaela Bot1, Dan Radu1
1a Department of Obstetrics and Gynaecology , Carol Davila University of Medicine and Pharmacy, Elias University Hospital , Bucharest , Romania.
Insights
Low-dose aspirin initiated before 11 weeks of pregnancy improved uterine blood flow and reduced preeclampsia risk. Early aspirin use positively impacts placentation parameters and pregnancy outcomes.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Pharmacology
Background:
- Preeclampsia is a significant cause of maternal and fetal morbidity.
- Early low-dose aspirin prophylaxis (before 16 weeks) shows promise in reducing preeclampsia rates.
- Investigating the impact of early aspirin initiation on first-trimester functional parameters is crucial.
Purpose of the Study:
- To evaluate the effect of early-onset low-dose aspirin on functional parameters at 11-14 weeks gestation.
- To assess the impact of preconception or early pregnancy aspirin initiation on placentation markers.
- To determine if early aspirin use reduces the calculated risk for early and late-onset preeclampsia.
Main Methods:
- Retrospective observational study of 128 women receiving low-dose aspirin before 14 weeks.
- Matched comparison with 1044 women who did not receive aspirin.
- Analysis of maternal, ultrasound (uterine artery PI), and biochemical (PAPP-A, free β hCG) markers.
Main Results:
- Aspirin initiated before 11 weeks significantly improved uterine blood flow (average uterine PI 1.7 vs. 2.22, p<0.05).
- Higher PAPP-A levels were observed in the early aspirin group (1.2 vs. 0.82, p>0.05).
- Reduced risk for early-onset (1:2141 vs. 1:333) and late-onset preeclampsia (1:361 vs. 1:99) was noted (p<0.05).
Conclusions:
- Early initiation of low-dose aspirin, particularly before 11 weeks, appears to improve placentation parameters.
- While not all results reached statistical significance, trends suggest benefits in uterine blood flow and reduced preeclampsia risk.
- Higher aspirin doses started early may enhance placental development and improve pregnancy outcomes.
Introduction:
There is recent evidence that prophylaxis with 150 mg of aspirin given before 14-16 weeks significantly reduces preeclampsia rates and may improve pregnancy outcome. We conducted an observational study that investigates the effect of low-dose aspirin initiated early in pregnancy or in preconception on functional parameters assessed at 11-14 weeks.
Materials And Methods:
We have retrospectively selected 128 pregnant women that presented for the first trimester screening for aneuploidies between 11+0 and 13+6 weeks of gestation and received low-dose aspirin before 14 weeks. We excluded cases with an estimated high risk for early preeclampsia (cut-off > 1:100). This group was matched to 1044 cases that did not receive aspirin in early pregnancy. We have selected for statistical analysis maternal parameters, ultrasound parameters (crown-rump length, nuchal translucency thickness, pulsatility index in uterine arteries - left, right, average and average uterine PI expressed in multiple of median (MoM)), first trimester maternal biochemical markers (free β hCG and PAPP-A expressed in MoM), and the calculated risk for early onset and late onset preeclampsia.
Results:
The most common dosages of aspirin were 75 mg (77 cases) and 100 mg (32 cases). The most significant results are within the aspirin group. In the subgroup that received aspirin before 11 weeks (110 cases), irrespective of the dosage, the uterine blood flow is significantly improved (average uterine PI 1.7 compared with 2.22, p < .05, (0.24-0.7) 95% CI) and the PAPP-A levels are higher (1.2 compared with 0.82, p > .05, [(-0.65) - 0.02] 95% CI). The estimated risk for both early and late onset preeclampsia in this group is reduced (1:2141 compared with 1:333 for early preeclampsia, p < .05, (1216-2398) 95% CI; 1:361 compared with 1:99 for late onset preeclampsia, p < .05, (173-351) 95% CI).
Conclusion:
Even though the results are not always statistically significant, they demonstrate that placentation parameters improve with higher doses of aspirin started before 11 weeks.
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