Low-dose aspirin is associated with reduced spontaneous preterm birth in nulliparous women

Andrikopoulou, Maria; Purisch, Stephanie; Handal-Orefice, Roxane; Gyamfi-Bannerman, Cynthia

doi:10.1016/j.ajog.2018.06.011

Cited by 67 publications

(61 citation statements)

References 35 publications

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“…Current research focuses on antiplatelet therapy as a new strategy in the prevention of PTB . Recent studies report a reduction in spontaneous PTB before 34 weeks if antiplatelet therapy is started between 13 and 25 weeks of gestation . We suggest increased surveillance in women with an abnormal UtA Doppler in the second trimester.…”

Section: Discussionmentioning

confidence: 78%

“…[25][26][27][28] Recent studies report a reduction in spontaneous PTB before 34 weeks if antiplatelet therapy is started between 13 and 25 weeks of gestation. 29 We suggest increased surveillance in women with an abnormal UtA Doppler in the second trimester. Further prospective studies should evaluate if abnormal UtA Doppler contributes to the multivariable etiology that is underlying spontaneous PTB.…”

Section: Discussionmentioning

confidence: 88%

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The predictive capacity of uterine artery Doppler for preterm birth—A cohort study

Zijl

Koullali

Mol

et al. 2020

Acta Obstet Gynecol Scand

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Introduction Mid‐trimester uterine artery resistance measured with Doppler sonography is predictive for iatrogenic preterm birth. In view of the emerging association between hypertensive disease in pregnancy and spontaneous preterm birth, we hypothesized that uterine artery resistance could also predict spontaneous preterm birth. Material and methods We performed a cohort study of women with singleton pregnancies. Uterine artery resistance was routinely measured at the 18‐22 weeks anomaly scan. Pregnancies complicated by congenital anomalies or intrauterine fetal death were excluded. We analyzed if the waveform of the uterine artery (no notch, unilateral notch or bilateral notch) was predictive for spontaneous and iatrogenic preterm birth, defined as delivery before 37 weeks of gestation. Furthermore, we assessed whether the uterine artery pulsatility index was associated with the risk of preterm birth. Results Between January 2009 and December 2016 we collected uterine Doppler indices and relevant outcome data in 4521 women. Mean gestational age at measurement was 19+6 weeks. There were 137 (3.0%) women with a bilateral and 213 (4.7%) with a unilateral notch. Mean gestational age at birth was 38+6 weeks. Spontaneous and iatrogenic preterm birth rates were 5.7% and 4.9%, respectively. Mean uterine artery resistance was 1.12 in the spontaneous preterm birth group compared with 1.04 in the term group (P = 0.004) The risk of preterm birth was increased with high uterine artery resistance (OR 2.9 per unit; 95% CI 2.4‐3.9). Prevalence of spontaneous preterm birth increased from 5.5% in women without a notch in the uterine arteries to 8.0% in women with a unilateral notch and 8.0% in women with a bilateral notch. For iatrogenic preterm birth, these rates were 3.9%, 13.6% and 23.4%, respectively. Likelihood ratios for the prediction of spontaneous preterm birth were 1.6 (95% CI 1.0‐2.6) and 1.9 (95% CI 1.0‐3.5) for unilateral and bilateral notches, respectively, and for iatrogenic preterm birth they were 3.6 (95% CI 2.5‐5.2) and 6.8 (95% CI 4.7‐9.9) for unilateral and bilateral notches, respectively. Of all women with bilateral notching, 31.4% delivered preterm. Conclusions Mid‐trimester uterine artery resistance measured at 18‐22 weeks of gestation is a weak predictor of spontaneous preterm birth.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 88%

The predictive capacity of uterine artery Doppler for preterm birth—A cohort study

Zijl

Koullali

Mol

et al. 2020

Acta Obstet Gynecol Scand

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“…In the recent years, much concern has been raised about the first-trimester screenings for APOs which are considered as a window of opportunity to predict and prevent these disorders [13]. In addition to preeclampsia, it has been reported that low-dose aspirin use during pregnancy is also effective in other APOs [35][36][37]. ACOG Committee opinion recommends that low-dose aspirin prophylaxis commenced optimally before 16 gestational weeks [4].…”

Section: Discussionmentioning

confidence: 99%

First-trimester maternal serum alpha-fetoprotein is not a good predictor for adverse pregnancy outcomes: a retrospective study of 3325 cases

Zhang

et al. 2019

Preprint

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Purpose: To investigate the predictive values of first-trimester maternal serum alpha-fetoprotein (MS-AFP) to preterm birth, stillbirth, preeclampsia and small for gestational age (SGA). Methods: We retrospectively reviewed the data on the first-trimester MS-AFP levels and pregnancy outcomes of 3325 singleton pregnant women. The cutoff value of 2.5 multiple of the median (MoM) was used to evaluate the risks of adverse pregnancy outcomes (APOs) regarding MS-AFP. The receiver operating characteristic (ROC) curves were used to evaluate the predictive efficiencies of MS-AFP to these disorders. Results: A total of 181 pregnancies resulted in preterm birth, 32 in stillbirth, 81 in preeclampsia, and 362 in SGA. Compared to women with MS-AFP < 2.5MoM, those with MS-AFP ≥ 2.5MoM had increased risks (odds ratio, 95% confidence interval) of preterm birth (2.53, 1.65~3.88), preeclampsia (3.05, 1.71~5.43) and SGA (1.90, 1.34~2.69), while the risk of stillbirth was not significantly increased (1.33, 0.40~4.41). The areas under ROC curves were 0.572 (P = 0.001), 0.597 (P = 0.060), 0.579 (P = 0.015) and 0.565 (P = 0.000) for preterm birth, stillbirth, preeclampsia and SGA, respectively. Women with MS-AFP ≥ 2.5MoM had an earlier distribution of gestational weeks at delivery (P = 0.004) and a lower distribution of neonatal birth weights (P = 0.000) compared to those with MS-AFP < 2.5MoM, but the actual between-group differences were minuscule. Conclusion: Elevated first-trimester MS-AFP is associated with increased risk of preterm birth, preeclampsia and SGA. However, the predictive efficiencies were low and it is not a good predictor for these APOs.

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“…In the recent years, much concern has been raised about the first-trimester screenings for APOs which are considered as a window of opportunity to predict and prevent these disorders [13]. In addition to preeclampsia, it has been reported that low-dose aspirin use during pregnancy is also effective in the prevention of other APOs [36][37][38]. ACOG Committee opinion recommends that low-dose aspirin prophylaxis commenced optimally before 16 gestational weeks [4].…”

Section: Discussionmentioning

confidence: 99%

First-trimester maternal serum alpha-fetoprotein is not a good predictor for adverse pregnancy outcomes: a retrospective study of 3325 cases

Zhang

et al. 2020

BMC Pregnancy Childbirth

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Background: It is well known that second-trimester maternal serum alpha-fetoprotein (MS-AFP) is a predictor for adverse pregnancy outcomes (APOs), such as preterm birth, stillbirth, preeclampsia and small for gestational age (SGA). However, it is unknown whether first-trimester MS-AFP is also predictive of APOs. Methods: We retrospectively reviewed the data on the first-trimester MS-AFP levels and pregnancy outcomes of 3325 singleton pregnant women. The cutoff value of 2.5 multiple of the median (MoM) was used to evaluate the risks of APOs regarding MS-AFP. The receiver operating characteristic (ROC) curves were used to evaluate the predictive efficiencies of MS-AFP to these disorders. Results: A total of 181 pregnancies resulted in preterm birth, 32 in stillbirth, 81 in preeclampsia, and 362 in SGA. Compared to women with MS-AFP < 2.5MoM, those with MS-AFP ≥ 2.5MoM had increased risks (odds ratio, 95% confidence interval) of preterm birth (2.53, 1.65~3.88), preeclampsia (3.05, 1.71~5.43) and SGA (1.90, 1.34~2.69), and had an earlier distribution of gestational weeks at delivery (P = 0.004) and a lower distribution of neonatal birth weights (P = 0.000), but the actual between-group differences were minuscule. The areas under ROC curves were 0.572 (P = 0.001), 0.579 (P = 0.015) and 0.565 (P = 0.000) for preterm birth, preeclampsia and SGA, respectively. Subdivisions for the disorders did not obviously improve the performances of MS-AFP. Conclusions: Elevated first-trimester MS-AFP is associated with increased risk of preterm birth, preeclampsia and SGA. However, the predictive efficiencies were low and it is not a good predictor for these APOs.

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Low-dose aspirin is associated with reduced spontaneous preterm birth in nulliparous women

Cited by 67 publications

References 35 publications

The predictive capacity of uterine artery Doppler for preterm birth—A cohort study

The predictive capacity of uterine artery Doppler for preterm birth—A cohort study

First-trimester maternal serum alpha-fetoprotein is not a good predictor for adverse pregnancy outcomes: a retrospective study of 3325 cases

First-trimester maternal serum alpha-fetoprotein is not a good predictor for adverse pregnancy outcomes: a retrospective study of 3325 cases

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