Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data

Askie, Lisa; Duley, Lelia; Henderson‐Smart, David J; Stewart, Lesley

doi:10.1016/s0140-6736(07)60712-0

Cited by 926 publications

(632 citation statements)

References 46 publications

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“…While there is currently no effective preventative measure, a recent meta-analysis has suggested that low-dose aspirin may reduce the incidence of pre-eclampsia by 10%. 44,45 Early identification of women at risk of pre-eclampsia facilitates targeted surveillance and intervention. 46,47 There are likely to be significant advantages in predicting preeclampsia in the first, as opposed to the second trimester; given that the disease process (failure of adequate trophoblastic invasion) is already established by the mid-second trimester, it seems likely that any successful preventative measure will need to be instituted as early in pregnancy as possible.…”

Section: Discussionmentioning

confidence: 99%

Pulse wave analysis: a preliminary study of a novel technique for the prediction of pre‐eclampsia

Khalil

Cooper

Harrington

2008

BJOG

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Objective To investigate whether first-trimester arterial pulse wave analysis (PWA) can predict pre-eclampsia.Design This was a prospective screening study.Setting The Homerton University Hospital, a London teaching hospital.Population Two hundred and ten low-risk women with a singleton pregnancy were analysed.Methods Radial artery pulse waveforms were measured between the 11 +0 and 13 +6 weeks of gestation and the aortic waveform derived by applying a generalised transfer function. Augmentation pressure (AP) and augmentation index at heart rate of 75 beats per minute (AIx-75), measures of arterial stiffness, were calculated. The multiple of the gestation-specific median in controls for AP and AIx-75 were calculated. Logistic regression models were developed and their predictive ability assessed using the area under the receiver operator curve.Main outcome measures Prediction of pre-eclampsia by AIx-75.Results Fourteen (6.7%) women developed pre-eclampsia, and 196 remained normotensive. Eight of the 14 women developed pre-eclampsia before 34 weeks of gestation (early-onset pre-eclampsia). For a false-positive rate of 11%, AIx-75 had a detection rate of 79% for all cases of pre-eclampsia and 88% for early-onset pre-eclampsia.Conclusion First-trimester arterial PWA can play a significant role in understanding the pathophysiology of pre-eclampsia and may play a role in early screening.

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Section: Discussionmentioning

confidence: 99%

Pulse wave analysis: a preliminary study of a novel technique for the prediction of pre‐eclampsia

Khalil

Cooper

Harrington

2008

BJOG

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“…8 Accurate prediction of pre-eclampsia and intrauterine growth restriction is crucial to allow judicious allocation of resources for monitoring and preventive treatment to improve maternal and perinatal outcomes. 9,10 However, studies investigating the predictive accuracy of uterine artery Doppler indices (Box 1) have revealed considerably varied results. Thus, it is questionable whether uterine artery Doppler ultrasonography should be used as a predictive test.…”

Section: 5mentioning

confidence: 99%

“…Currently, no pharmacologic treatment or management strategy has been shown to be effective in preventing preeclampsia or intrauterine growth restriction or ameliorating their complications. Research into treatment with acetylsalicylic acid, which is inexpensive and readily available, has shown a small preventive effect (relative risk 0.9 for both preeclampsia and intrauterine growth restriction) 10 in the absence of any serious side effects. In this case, a false-negative test result is potentially more harmful than a false-positive test result.…”

Section: -39mentioning

confidence: 99%

Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis

Cnossen¹,

Morris²,

Riet³

et al. 2008

Canadian Medical Association Journal

643

403

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Background: : Alterations in waveforms in the uterine artery are associated with the development of pre-eclampsia and intrauterine growth restriction. We investigated the predictive accuracy of all uterine artery Doppler indices for both conditions in the first and second trimesters. Methods: :We identified relevant studies through searches of MEDLINE, EMBASE, the Cochrane Library and Medion databases (all records to April 2006) and by checking bibliographies of identified studies and consulting with experts. Four of us independently selected studies, extracted data and assessed study validity. We performed a bivariable meta-analysis of sensitivity and specificity and calculated likelihood ratios. Results:We identified 74 studies of pre-eclampsia (total 79 547 patients) and 61 studies of intrauterine growth restriction (total 41 131 patients). Uterine artery Doppler ultrasonography provided a more accurate prediction when performed in the second trimester than in the first-trimester. Most Doppler indices had poor predictive characteristics, but this varied with patient risk and outcome severity. An increased pulsatility index with notching was the best predictor of pre-eclampsia (positive likelihood ratio 21.0 among high-risk patients and 7.5 among low-risk patients). It was also the best predictor of overall (positive likelihood ratio 9.1) and severe (positive likelihood ratio 14.6) intrauterine growth restriction among low-risk patients.Interpretation: Abnormal uterine artery waveforms are a better predictor of pre-eclampsia than of intrauterine growth restriction. A pulsatility index, alone or combined with notching, is the most predictive Doppler index. These indices should be used in clinical practice. Future research should also concentrate on combining uterine artery Doppler ultrasonography with other tests. Abstract CMAJ 2008;178(6):701-11From the Departments of General Practice (Cnossen, ter Riet, Bindels), of Obstetrics and Gynaecology (Cnossen, Mol, van der Post) and

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“…Moreover, lupus nephritis has also been specifically linked to this complication in a recent systematic review (7). Low-dose aspirin has been shown to significantly reduce the frequency of preeclampsia, the risk of delivery before 34 weeks, and serious adverse obstetric outcomes in high-risk women (8), and would similarly be recommended. Further, hydroxychloroquine reduced preeclampsia in a small trial in pregnant women with lupus (9).…”

Section: To the Editormentioning

confidence: 99%

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Katz

Shin

Wallhagen

2013

Arthritis Care & Research

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Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data

Cited by 926 publications

References 46 publications

Pulse wave analysis: a preliminary study of a novel technique for the prediction of pre‐eclampsia

Pulse wave analysis: a preliminary study of a novel technique for the prediction of pre‐eclampsia

Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis

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