Review of the evidence for risks for taking aspirin in pregnancy for preeclampsia prevention
The American College of Obstetricians and Gynecologists (ACOG) is responsible for producing practice guidelines and educational materials for OB/GYN doctors. One of the recommendations by ACOG is that women at high risk for preeclampsia take low dose aspirin while pregnant to try to reduce this risk. However, some doctors, researchers, and patients have expressed concern for what effect low-dose aspirin may have on the baby while moms take it during pregnancy. This article is a review of all of the evidence that supports that it is safe to take low-dose aspirin in pregnancy, and that the benefit of possibly preventing preeclampsia outweighs the risk of taking the medicine. Authors describe that “several prior studies have shown that…low-dose aspirin during pregnancy has no negative association with perinatal morbidity and mortality.” Read the original article here.
Editors Note: The Preeclampsia Foundation has published patient information and materials about aspirin for the prevention of preeclampsia, found here.
Using levels of sFlt-1 and PlGF in mom's blood in pregnancy to predict preeclampsia
Levels of two molecules- sFlt-1 and PlGF- have been linked to preeclampsia in research studies. Now doctors are working to find a way to use these measurements of sFlt-1 and PlGF in the real world clinical setting to help predict and diagnose preeclampsia. There were 370 women enrolled in this study. Investigators tested whether or not knowing a patient’s sFlt-1 and PlGF levels (before preeclampsia diagnosis) could help doctors detect preeclampsia. In the study, when a patient was suspected to have preeclampsia, levels of sFlt-1 and PlGF were measured in her blood. Then, for half of these patients, the study told the patient’s doctor her levels and that information could be used in her clinical management (for example, admitting her to the hospital to treat her suspected preeclampsia). For the other half of patients (the “control” group), the doctors were not told patients’ levels. In the study results, researchers found doctors that knew sFlt-1/PlGF levels were able to admit 100% of the women that developed preeclampsia within 7 days. Using these levels improved the accuracy of predicting preeclampsia. Read the original article here.
Editor's note: The strength of this study is in how it was designed. Most studies of these two molecules, sFlt-1 and PlGF, have been retrospective- meaning the research questions are answered with data from events that have happened in the past (for example, from patients who have already been diagnosed with preeclampsia or have already delivered their babies). This study is prospective- meaning that researchers enrolled patients in the study and waited for events to happen (like preeclampsia diagnosis). A prospective study helps you be more confident linking causes and effects.
Using PlGF (Placental growth factor) to Predict Preeclampsia
Many studies have found that lower levels of the hormone PlGF (placental growth factor) in pregnant women has been linked to preeclampsia, although not every study has been able to reproduce this finding. Researchers combined data across 40 studies (total of 92,687 patients) that each measured PlGF levels and collected data on preeclampsia diagnosis. This type of study (combining data from studies that collected similar data) is called a meta-analysis. After combining all the data, researchers found overall that PlGF levels were a useful screening tool to help doctors predict if a patient may develop preeclampsia later in pregnancy. The study also found that the most helpful time to use PlGF levels was after 14 weeks of pregnancy and PlGF levels were best at predicting early onset preeclampsia (where signs and symptoms of preeclampsia present before 34 weeks of pregnancy). Read the original article here.
Weight change between pregnancies can increase risk of preeclampsia
Obstetrics & Gynecology
Researchers asked if there was a relationship between weight change between pregnancies and a mother’s risk of developing a hypertensive disorder of pregnancy (like preeclampsia) in the upcoming pregnancy. To answer this question, a meta-analysis study was completed combining data from 12 studies (415,605 women all together). Study results showed an increased risk of a hypertensive disorder of pregnancy with weight gain between pregnancies, and a decreased risk with weight loss between pregnancies. Read the original article here.
Preeclampsia survivors are at increased risk for cardiovascular disease
Journal of the American College of Cardiology
Epidemiology studies (meaning studies of population data, like from electronic medical records) have repeatedly shown preeclampsia survivors have an increased risk of cardiovascular disease in later life. However, detailed studies of how their cardiovascular system changes as the cardiovascular disease develops are rare. In this cutting edge study, researchers studied women from the UK Biobank, a larger study that follows mothers after their pregnancies - 220,024 women total; 2,808 had a hypertensive disorder of pregnancy. The researchers collected measurements on mother’s hearts when they were in their 50’s and 60’s. The study found women with a history of a hypertensive disorder of pregnancy (including preeclampsia) were more likely to have high blood pressure, arterial stiffness, coronary heart disease, heart failure, aortic stenosis, and mitral regurgitation. Read the original article here.
Experiences and lifestyle changes in preeclampsia survivors
BMC Pregnancy and Childbirth
Knowing surviving preeclampsia puts you at risk for cardiovascular disease later in life, researchers wanted to interview preeclampsia survivors to learn about their feelings about lifestyle changes to improve their heart health for the future. This study surveyed 17 preeclampsia survivors and women who had gestational diabetes in pregnancy about their experiences and motivations/needs for information to help improve their future health. Of the preeclampsia survivors enrolled, women reported feeling like they needed individualized care to help them process their traumatic birth experiences before they could successfully improve their lifestyle. Survivors also felt that their partners should be included in the education they receive about improving their lifestyle to make them healthier in the future. The study also found that giving survivors lifestyle education earlier increased her motivation to change their lifestyle. Read the original article here.
Risk assessment for early-onset preeclampsia in the United States
Obstetrics & Gynecology
In May of 2018, the Gottesfeld-Hohler Memorial Foundation put together a meeting of global experts in the field of preeclampsia with the goal of “determining the appropriate preeclampsia risk-assessment strategy and to consider consequent treatments and interventions for the U.S. population.” Experts discussed current screening practices, guidelines, and the gaps in knowledge we still have in calculating a patient’s risk for preeclampsia and how best to prevent preeclampsia in women who are at risk. They also discussed and outlined what future research studies still need to be done. One of their strongest recommendation was for a study that gives low-dose aspirin to all pregnant women. Read the original article here.
RESEARCH ROUNDUP TEAM
Article selections for the Research Roundup are guided by Dr. Elizabeth Sutton and a team of preeclampsia experts: Dr. Jenny Sones, Dr. Alisse Hauspurg, Dr. Felicia LeMoine, and Dr. Michelle Ogunwole.
About Dr. Elizabeth Sutton
Research Roundup Editor
Dr. Elizabeth Sutton is the Research Roundup Editor for the Preeclampsia Foundation, while serving full-time as the Scientific Research Director at Woman's Hospital in Baton Rouge, Louisiana. Dr. Sutton is a preeclampsia survivor and researcher with a PhD in Molecular and Developmental Biology from Louisiana State University. Her research efforts are focused on the short and long-term cardiovascular and metabolic consequences of preeclampsia in mothers and their children. Her work has been published in numerous scientific journals including Cell Metabolism, Obstetrics & Gynecology, Diabetes, and the American Journal of Physiology. Dr. Sutton is dedicating her life's work to the study of preeclampsia and the dissemination of health education to preeclampsia survivors to honor her resilient daughter, Willow (born at 35 weeks from preeclampsia with severe features in 2017). Her second child, Gregory, was born in 2019 at 40 weeks after a normotensive pregnancy.
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