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Aspirin in pregnancy

Rose G Radin, Lindsey A Sjaarda, Neil J Perkins, Robert M Silver, Zhen Chen, Laurie L Lesher, Noya Galai, Jean Wactawski-Wende, Sunni L Mumford, Enrique F Schisterman
CONTEXT: Among women with a single, recent pregnancy loss, daily preconception low-dose aspirin (LDA) increased the live birth rate with no effect on pregnancy loss. The mechanism underlying this effect is unclear, but it may work through ovulation. OBJECTIVE: We estimated the effect of LDA on the per-cycle risk of anovulation among eumenorrheic women. DESIGN: The Effects of Aspirin in Gestation and Reproduction trial, a multi-center, randomized, double-blind, placebo-controlled trial of daily LDA on reproductive outcomes...
October 18, 2016: Journal of Clinical Endocrinology and Metabolism
Bassam Haddad, Norbert Winer, Yvon Chitrit, Véronique Houfflin-Debarge, Céline Chauleur, Karine Bages, Vassilis Tsatsaris, Alexandra Benachi, Florence Bretelle, Jean-Christophe Gris, Sylvie Bastuji-Garin
OBJECTIVE: To evaluate whether daily enoxaparin, added to low-dose aspirin, started before 14 weeks of gestation reduces placenta-mediated complications in pregnant women with previous severe preeclampsia diagnosed before 34 weeks of gestation. METHODS: In this open-label multicenter randomized trial, we enrolled consenting pregnant women with previous severe preeclampsia diagnosed before 34 weeks of gestation, gestational age at randomization of 7-13 weeks, singleton pregnancy, and no plan for anticoagulation...
October 6, 2016: Obstetrics and Gynecology
Ozan Ünlü, Stephane Zuily, Doruk Erkan
Antiphospholipid syndrome (APS) is the association of thrombosis and/or pregnancy morbidity with antiphospholipid antibodies (aPL). Thirty to forty percent of systemic lupus erythematosus (SLE) patients are tested positive for aPL, which may have an impact on the SLE presentation, management, and prognosis. Compared with SLE patients without aPL, those with aPL have a higher prevalence of thrombosis, pregnancy morbidity, valve disease, pulmonary hypertension, livedo reticularis, thrombocytopenia, hemolytic anemia, acute/chronic renal vascular lesions, and moderate/severe cognitive impairment; worse quality of life; and higher risk of organ damage...
June 2016: Eur J Rheumatol
A D Gernand, H N Simhan, K M Baca, S Caritis, L M Bodnar
OBJECTIVE: To examine the relation between maternal vitamin D status and risk of pre-eclampsia and preterm birth in women at high risk for pre-eclampsia. DESIGN: Analysis of prospectively collected data and blood samples from a trial of prenatal low-dose aspirin. SETTING: Thirteen sites across the USA. POPULATION: Women at high risk for pre-eclampsia. METHODS: We measured 25-hydroxyvitamin D [25(OH)D] concentrations in stored maternal serum samples drawn at 12-26 weeks' gestation (n = 822)...
October 5, 2016: BJOG: An International Journal of Obstetrics and Gynaecology
Mariya Angelova, Ivan Todorov, Emil Kovachev
AIM: To determine the prognostic value of the low Pregnancy-associated plasma protein A (PAPP-A) levels in the early stages of pregnancy (11-13 weeks GA) independently and in combination with a Doppler test of the uterine arteries during the second half of pregnancy (22-23 weeks GA). MATERIAL AND METHODS: The study covered the period 2010-2011 and included 106 pregnant women, aged 35-40, with a single child pregnancy. The research excluded pregnant women with anomalies of the fetus, smokers and women taking prophylactically low doses of aspirin...
September 15, 2016: Open Access Macedonian Journal of Medical Sciences
Stefanie N Hinkle, Sunni L Mumford, Katherine L Grantz, Robert M Silver, Emily M Mitchell, Lindsey A Sjaarda, Rose G Radin, Neil J Perkins, Noya Galai, Enrique F Schisterman
Importance: Nausea and vomiting during pregnancy have been associated with a reduced risk for pregnancy loss. However, most prior studies enrolled women with clinically recognized pregnancies, thereby missing early losses. Objective: To examine the association of nausea and vomiting during pregnancy with pregnancy loss. Design, Setting, and Participants: A randomized clinical trial, Effects of Aspirin in Gestation and Reproduction, enrolled women with 1 or 2 prior pregnancy losses at 4 US clinical centers from June 15, 2007, to July 15, 2011...
September 26, 2016: JAMA Internal Medicine
Stéphanie Roberge, Kypros Nicolaides, Suzanne Demers, Jon Hyett, Nils Chaillet, Emmanuel Bujold
BACKGROUND: Preeclampsia (PE) and fetal growth restriction (FGR) are major causes of perinatal death and handicap in survivors. Randomized clinical trials (RCTs) have reported that the risk of PE, severe PE and FGR can be reduced by the prophylactic use of aspirin in high-risk women, but the appropriate dose of the drug to achieve this objective is not certain. OBJECTIVE: To estimate the impact of aspirin dosage on the prevention of PE, severe PE and FGR. STUDY DESIGN: We performed a systematic review and meta-analysis of RCTs comparing the effect of daily aspirin or placebo (or no treatment) during pregnancy...
September 15, 2016: American Journal of Obstetrics and Gynecology
Stefan C Kane
The commercial availability of tests in the first trimester of pregnancy that predict the later development of pre-eclampsia has prompted considerable debate regarding their clinical utility and the degree to which they fulfil the longstanding principles of screening. Such tests have been shown to achieve detection rates for early pre-eclampsia (requiring delivery prior to 34 weeks) of over 90%, for a false positive rate of 10%. However, their capacity to predict later onset pre-eclampsia, which accounts for the bulk of the disease burden, is much more limited...
September 2016: Obstetric Medicine
Jiao Fan, Yiping Zhong, Cuina Chen
LABELED PROBLEM: Antinuclear antibody (ANA) could cause reproductive failure. But treatment for women with antinuclear antibody was controversial. METHODS: One hundred and thirty-three ANA+ women with one-time in vitro fertilization (IVF) implantation failure were divided into two groups randomly. The study group comprised 60 sero-positive for antinuclear antibody. These patients were treated with prednisone (10 mg/day) and aspirin (100 mg/day) starting 3 months before induction of ovulation in 60 IVF cycles...
November 2016: American Journal of Reproductive Immunology: AJRI
Hind N Moussa, Mateo G Leon, Ana Marti, Alissar Chediak, Claudia Pedroza, Sean C Blackwell, Baha M Sibai
Objective The American Congress of Obstetricians and Gynecologists (ACOG) task force on hypertension in pregnancy introduced a new definition of superimposed preeclampsia (SIP) adding severe features (SF) as new criteria to define severe disease. They also recommended that those with SIP be delivered ≥ 37 weeks, whereas those with SF be delivered ≤ 34 weeks. Our aim was to investigate the validity of this new definition by comparing adverse pregnancy outcomes in SIP with (SIP-SF) and without SF (SIP)...
September 8, 2016: American Journal of Perinatology
Carolien N H Abheiden, Birgit S Blomjous, Sylvia J Kroese, Irene E M Bultink, Ruth D E Fritsch-Stork, A Titia Lely, Marjon A de Boer, Johanna I P de Vries
OBJECTIVE: To relate anticoagulant use to pregnancy complications in women with systemic lupus erythematosus (SLE) and primary antiphospholipid syndrome (APS). METHODS: All ongoing pregnancies, 184, in two Dutch tertiary centers between 2000 and 2015. RESULTS: LMWH and aspirin was prescribed in 15/109 SLE women without antiphospholipid antibodies (aPL), 5/14 with aPL, 11/13 with APS, 45/48 with primary APS. Main complications in the four treatment groups (no anticoagulant treatment, aspirin, LMWH, aspirin and LMWH) included hypertensive disorders of pregnancy (9...
September 6, 2016: Hypertension in Pregnancy
Qingyun Mai, Xiaokun Hu, Gang Yang, Yingyi Luo, Kejun Huang, Yuan Yuan, Canquan Zhou
BACKGROUND: Ovarian hyperstimulation syndrome is an iatrogenic complication of controlled ovarian stimulation. Early ovarian hyperstimulation syndrome occurs during luteal phase of controlled ovarian stimulation within 9 days after human chorionic gonadotropin trigger and reflects an acute consequence of this hormone on the ovaries. Late ovarian hyperstimulation syndrome occurs 10 or more days after human chorionic gonadotropin trigger and reflects increased endogenous human chorionic gonadotropin levels following pregnancy...
August 20, 2016: American Journal of Obstetrics and Gynecology
Akihide Ohkuchi, Chikako Hirashima, Kayo Takahashi, Hirotada Suzuki, Shigeki Matsubara
The most common classifications of hypertensive disorders of pregnancy consist of chronic hypertension, gestational hypertension, preeclampsia (PE) and superimposed PE. A common final pathophysiology of PE is endothelial dysfunction. The most successful translational research model for explaining the cause-effect relationship in the genesis of PE is the angiogenic/angiostatic balance theory, involving soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF) and soluble endoglin (sEng). In a systematic review of articles on the prediction of early-onset PE using angiogenesis-related factors, we revealed that the prediction of early-onset PE in the first trimester is clinically possible, but the prediction of early-onset PE in the early third trimester might be ideal...
August 18, 2016: Hypertension Research: Official Journal of the Japanese Society of Hypertension
N Todorov
UNLABELLED: The preeclampsia is one of the most serious complications in the second half of the pregnancy with a high risk of perinatal maternal and neonatal mortality. The study is aiming to determine which pregnant women have a higher risk of developing preeclampsia with a view to the subsequent antenatal care, on the base of the individual factors. MATERIAL AND METODS: From prospectively followed pacients is collected information by a questionnaire and sonographic examination at 11-13 weeks of gestation/w...
2016: Akusherstvo i Ginekologii︠a︡
C N Wijeyaratne, Sla Galappaththi, E Palipane, Dbia Jayawardane, S H Dodampahala, M N Tudawe, L V Gooneratne, R de Silva, D Ratnayake, S L Seneviratne
PROBLEM: Antiphospholipid syndrome is associated with recurrent pregnancy loss, and specific treatment improves pregnancy outcome. Laboratory diagnosis is limited in South Asia. We assessed management outcomes of definite/probable antiphospholipid syndrome treated at a tertiary centre in Sri Lanka. METHOD: Descriptive cross-sectional study of pregnancy outcomes with heparin and aspirin therapy. OUTCOME MEASURES: miscarriage, intrauterine death and live birth when compared to previous untreated pregnancies...
June 2016: Obstetric Medicine
Nicla A Varnier, Franzisca Pettit, David Rees, Steven Thou, Mark Brown, Amanda Henry
BACKGROUND: Cardiovascular disease affects 0.2-4% of pregnancies. Coupled with the physiological stress of pregnancy, cardiovascular disease may present significant management challenges including appropriate risk:benefit analysis of medical and surgical management options. CASE: A 33-year-old gravida 4 para 1 miscarriage 2 presented at 18 weeks' gestation to the high-risk pregnancy service with a history of coronary artery disease and homozygous familial hypercholesterolaemia...
September 2015: Obstetric Medicine
K Neykova, V Dimitrova, R Dimitrov, L Vakrilova
AIM: To analyze pregnancy outcome in patients who were on antithrombotic medication (AM) because of previous pregnancy with fetal intrauterine growth restriction (IUGR). MATERIALS AND METHODS: The studied group (SG) included 21 pregnancies in 15 women with history of previous IUGR. The patients were on low dose aspirin (LDA) and/or low molecular weight heparin (LMWH). Pregnancy outcome was compared to the one in two more groups: 1) primary group (PG) including the previous 15 pregnancies with IUGR of the same women; 2) control group (CG) including 45 pregnancies of women matched for parity with the ones in the SG, with no history of IUGR and without medication...
2016: Akusherstvo i Ginekologii︠a︡
L Andreoli, G K Bertsias, N Agmon-Levin, S Brown, R Cervera, N Costedoat-Chalumeau, A Doria, R Fischer-Betz, F Forger, M F Moraes-Fontes, M Khamashta, J King, A Lojacono, F Marchiori, P L Meroni, M Mosca, M Motta, M Ostensen, C Pamfil, L Raio, M Schneider, E Svenungsson, M Tektonidou, S Yavuz, D Boumpas, A Tincani
OBJECTIVES: Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). METHODS: Systematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus. RESULTS: Family planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes...
July 25, 2016: Annals of the Rheumatic Diseases
Eleftheria Lefkou, Apostolos Mamopoulos, Themistoklis Dagklis, Christos Vosnakis, David Rousso, Guillermina Girardi
BACKGROUND: Administration of conventional antithrombotic treatment (low-dose aspirin plus low-molecular weight heparin [LDA+LMWH]) for obstetric antiphospholipid syndrome (APS) does not prevent life-threatening placenta insufficiency-associated complications such as preeclampsia (PE) and intrauterine growth restriction (IUGR) in 20% of patients. Statins have been linked to improved pregnancy outcomes in mouse models of PE and APS, possibly due to their protective effects on endothelium...
August 1, 2016: Journal of Clinical Investigation
Anush Martirosyan, Martin Petrek, Amit Kishore, Gayane Manukyan
Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by thrombosis and recurrent fetal loss, with the persistent presence of antiphospholipid antibodies (aPLs). aPLs exert their pathogenic effect via the overproduction of tissue factor and activation of complement and several cell types, including endothelial cells, platelets and notably monocytes. As a result, a hypercoagulable state develops leading to APS-associated obstetric complications and fetal loss. Despite being far from optimal, treatment of APS usually includes heparin and low dose aspirin...
August 2016: Experimental and Therapeutic Medicine
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