Low dose aspirin started before 16 weeks gestation and calcium supplementation after 20 weeks gestation in low-intake populations can prevent the onset of pre-eclampsia in pregnancies at risk of the condition, states a new review published today in The Obstetrician & Gynaecologist (TOG). It is also possible to assess a woman’s risk of developing pre-eclampsia from as early as 11 weeks of pregnancy, say the authors.
Pre-eclampsia is a condition which affects 3–5% of pregnancies and accounts for more than 50,000 maternal deaths annually worldwide. It is associated with complications including stroke, eclampsia, multiple-organ failure, fetal growth restriction, intrauterine death and preterm labour.
The condition is characterised by a combination of raised blood pressure (hypertension) and protein in the urine.
The review paper summarises evidence on pre-eclampsia surveillance in the first and second trimester and prevention using low dose aspirin and calcium supplementation.
Low dose aspirin commenced prior to 16 weeks of gestation has been demonstrated to have a statistically significant effect in the prevention of pre-eclampsia, as has the use of calcium supplementation in women that are calcium deficient.
It is also possible to assess a woman’s risk of developing pre-eclampsia from as early as 11 weeks of gestation. Part of this risk assessment includes blood pressure monitoring, biochemical marker levels and uterine artery Doppler assessment.
For optimal risk assessment, the authors state that a combination of investigations inclusive of maternal history, biophysical and biochemical marker screening should be performed between 11 and 13+6 weeks gestation.
The authors conclude by saying that whilst treatment is currently reserved for at-risk pregnancies, in the future management may be tailored around preventative treatment based on the results of first trimester screening. They also state that more research is needed to see if these therapies could be beneficial in low- risk populations.
Fionnuala Mone, Clinical Fellow, UCD School of Medicine and Medical Science, University College Dublin, and co-author of the review said:
“Use of low dose aspirin and calcium supplementation in at-risk populations can reduce the risk of developing pre-eclampsia, a serious condition which can lead to complications for both the mother and her baby. It is important to see if low-risk women can benefit from preventative treatments and screening through future research.”
Jason Waugh, TOG Editor-in-chief added:
“First trimester testing is a potential tool for clinicians to screen and then subsequently offer prophylaxis to prevent pre-eclampsia. However not all units will have access to sonographers trained in uterine artery Doppler or laboratories able to analyse biochemical marker levels and this needs to be taken into account if first trimester screening is extended to low-risk pregnancies.”
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The Obstetrician & Gynaecologist (TOG) is published quarterly and is the Royal College of Obstetricians and Gynaecologists’ (RCOG) medical journal for continuing professional development. TOG is an editorially independent, peer reviewed journal aimed at providing health professionals with updated information about scientific, medical and clinical developments in the specialty of obstetrics and gynaecology.
Mone F, McAuliffe FM. Low-dose aspirin and calcium supplementation for the prevention of pre-eclampsia. The Obstetrician & Gynaecologist 2014: http://dx.doi.org/10.1111/tog.12111