Aspirin for Prevention of Preeclampsia in Lupus Pregnancy

Abstract

Preeclampsia, the onset of hypertension and proteinuria during pregnancy, is a common medical disorder with high maternal and fetal mortality and morbidity. The underlying pathology remains poorly understood and includes inflammation, endothelial dysfunction, and an unbalanced thromboxane A2/prostacyclin ratio. For women with systemic lupus erythematosus (SLE), particularly those with preexisting renal disease or with active lupus, the risk of developing preeclampsia is up to 14% higher than it is among healthy individuals. The mechanism is still unknown and the data for preventing preeclampsia in lupus pregnancies are rare. Modulating the impaired thromboxane A2/prostacyclin ratio by administration of low-dose aspirin appears to be the current best option for the prevention of preeclampsia. After providing an overview of the pathogenesis of preeclampsia, preeclampsia in lupus pregnancies, and previous trials for prevention of preeclampsia with aspirin treatment, we recommend low-dose aspirin administration for all lupus patients starting prior to 16 weeks of gestation. Patients with SLE and antiphospholipid syndrome should receive treatment with heparin and low-dose aspirin during pregnancy.

Low-molecular-weight heparin and aspirin use in relation to pregnancy outcome in women with systemic lupus erythematosus and antiphospholipid syndrome: A cohort study

“…This is, amongst others, derived from studies finding a beneficial effect of aspirin in other populations at high risk for HD or intra-uterine growth (10). Furthermore, treatment with LMWH in addition to treatment with aspirin was advised for women with either primary or secondary APS in review and overview articles (7,9,17,18). In women with SLE and aPL, authors of two retrospective studies suggested that LMWH treatment during pregnancy might be beneficial to reduce maternal and perinatal pregnancy …”

“…Due to limited sideeffects and proven beneficial effects in other high-risk populations, the recommendation to use aspirin in the prevention of pregnancy complications was extended to women with SLE and primary APS (7,10).…”

“…Aspirin is also often prescribed in women with SLE and/or primary APS without evidence from an RCT, since it prevents recurrent HD in other populations (7)(8)(9)(10). To our knowledge, differences in pregnancy outcomes in relation to the use of LMWH and aspirin between women with SLE without aPL, SLE with aPL, SLE with APS and primary APS have not been well described yet.…”

The clinical significance of antiphospholipid antibodies in systemic lupus erythematosus

“…A later follow-up meta-analysis demonstrated that LDA initiated at or before 16 weeks reduces the risk of severe, but not mild, preeclampsia (124). Although lupus and/or aPL-positive patients are not included in these studies, these patients are at increased the risk of preeclampsia (125). Thus, independent of aPL, several groups recommend LDA for all lupus patients, even without a history of pregnancy morbidity (117,118,(126)(127)(128); however, there are no clinical trials supporting this recommendation.…”

Adjunctive Use of Esomeprazole in the Treatment of Pre-Eclampsia: A Case Report and Literature Review

“…This oligonephropathy increases risk for systemic and glomerular hypertension in adult life. [97][98] Additionally, the hypoxic and pro-inflammatory environment of the maternofetal unit results in epigenetic programming which impinges on the child's cardiometabolic and neuropsychiatric health. [ The anti-platelet drug aspirin is recommended for pre-eclampsia prevention.…”