Maternal cardiac function in women at high-risk for pre-eclampsia treated with 150 mg aspirin or placebo: an observational study

TY - JOUR

T1 - Maternal cardiac function in women at high-risk for pre-eclampsia treated with 150 mg aspirin or placebo

T2 - an observational study

AU - Ling, H Z

AU - Jara, P G

AU - Bisquera, A

AU - Poon, L C

AU - Nicolaides, K H

AU - Kametas, N A

N1 - © 2020 Royal College of Obstetricians and Gynaecologists.

PY - 2020/7/1

Y1 - 2020/7/1

N2 - OBJECTIVE: To compare maternal haemodynamics in women at low and high risk for preterm pre-eclampsia (PE), and between those at high risk who are randomised to aspirin or placebo.DESIGN: Prospective, longitudinal observational study.SETTING: Maternity units in six UK hospitals.POPULATION: Women participating in the Aspirin for Prevention of Preterm Pre-eclampsia (ASPRE) trial. The population comprised three groups of women: low risk for preterm PE (n = 1362), high risk for preterm PE treated with aspirin (n = 208), and high risk for preterm PE on placebo (n = 220).METHODS: Women had four visits during pregnancy: 11-14, 19-24, 30-34, and 35-37 weeks' gestation. Blood pressure was measured with a device validated for pregnancy, and PE and maternal haemodynamics were assessed with a bioreactance monitor at each visit. A multilevel linear mixed-effects analysis was performed to examine longitudinal changes of maternal haemodynamic variables, controlling for demographic characteristics, past medical history, and medication use.MAIN OUTCOME MEASURES: Longitudinal changes of cardiac output (CO), mean arterial pressure (MAP), and peripheral vascular resistance (PVR).RESULTS: The low-risk group demonstrated the expected changes with an increase in CO and reduction in MAP and PVR, with a quadratic change across gestation. In contrast, the high-risk groups had a declining CO, and higher MAP and PVR during pregnancy. The administration of aspirin did not appear to affect maternal haemodynamics.CONCLUSIONS: Women screened as high risk for preterm PE have a pathological cardiac adaptation to pregnancy and the prophylactic use of aspirin (150 mg oral daily from the first trimester) in this group may not alter this haemodynamic profile.TWEETABLE ABSTRACT: In women at high risk of pre-eclampsia, prophylactic use of aspirin may not alter the impaired maternal cardiac adaptation.

AB - OBJECTIVE: To compare maternal haemodynamics in women at low and high risk for preterm pre-eclampsia (PE), and between those at high risk who are randomised to aspirin or placebo.DESIGN: Prospective, longitudinal observational study.SETTING: Maternity units in six UK hospitals.POPULATION: Women participating in the Aspirin for Prevention of Preterm Pre-eclampsia (ASPRE) trial. The population comprised three groups of women: low risk for preterm PE (n = 1362), high risk for preterm PE treated with aspirin (n = 208), and high risk for preterm PE on placebo (n = 220).METHODS: Women had four visits during pregnancy: 11-14, 19-24, 30-34, and 35-37 weeks' gestation. Blood pressure was measured with a device validated for pregnancy, and PE and maternal haemodynamics were assessed with a bioreactance monitor at each visit. A multilevel linear mixed-effects analysis was performed to examine longitudinal changes of maternal haemodynamic variables, controlling for demographic characteristics, past medical history, and medication use.MAIN OUTCOME MEASURES: Longitudinal changes of cardiac output (CO), mean arterial pressure (MAP), and peripheral vascular resistance (PVR).RESULTS: The low-risk group demonstrated the expected changes with an increase in CO and reduction in MAP and PVR, with a quadratic change across gestation. In contrast, the high-risk groups had a declining CO, and higher MAP and PVR during pregnancy. The administration of aspirin did not appear to affect maternal haemodynamics.CONCLUSIONS: Women screened as high risk for preterm PE have a pathological cardiac adaptation to pregnancy and the prophylactic use of aspirin (150 mg oral daily from the first trimester) in this group may not alter this haemodynamic profile.TWEETABLE ABSTRACT: In women at high risk of pre-eclampsia, prophylactic use of aspirin may not alter the impaired maternal cardiac adaptation.

KW - Aspirin

KW - cardiac function

KW - cardiac output

KW - haemodynamics

KW - peripheral vascular resistance

KW - pre-eclampsia

UR - http://www.scopus.com/inward/record.url?scp=85083357705&partnerID=8YFLogxK

U2 - 10.1111/1471-0528.16193

DO - 10.1111/1471-0528.16193

M3 - Article

C2 - 32133780

SN - 1470-0328

VL - 127

SP - 1018

EP - 1025

JO - BJOG

JF - BJOG

IS - 8

ER -