scholarly journals Low-dose aspirin for preventing intrauterine growth restriction and pre-eclampsia in sickle cell pregnancy (PIPSICKLE): a randomised controlled trial (study protocol)

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e047949
Author(s):  
Bosede Bukola Afolabi ◽  
Ochuwa Adiketu Babah ◽  
Titilope Adenike Adeyemo ◽  
Oluwakemi Ololade Odukoya ◽  
Chinyere Veronica Ezeaka ◽  
...  
Keyword(s):  
Sickle Cell ◽  
Intrauterine Growth Restriction ◽  
Low Dose ◽  
Perinatal Death ◽  
Controlled Trial ◽  
Intrauterine Growth ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Ethical Approval ◽  
Randomised Controlled

IntroductionPregnancy in sickle cell disease is fraught with many complications including pre-eclampsia (PE) and intrauterine growth restriction (IUGR). Previously, we found an abnormality in prostacyclin–thromboxane ratio in sickle cell pregnant women, a situation that is also found in non-sickle pregnancies with PE and unexplained IUGR. Low-dose aspirin (LDA) has been shown to reduce the incidence of PE and IUGR in high-risk women by reducing the vasoconstrictor thromboxane while sparing prostacyclin, in effect ‘correcting’ the ratio. It has been found to be safe for use in pregnancy but has not been tested in sickle cell pregnancy. We hypothesise that LDA will reduce the incidence of IUGR and PE in pregnant haemoglobin SS (HbSS) and haemoglobin SC (HbSC) women.Methods and analysisThis is a multisite, double blind, randomised controlled trial, comparing a daily dose of 100 mg aspirin to placebo, from 12 to 16 weeks’ gestation until 36 weeks, in Lagos state, Nigeria. Four hundred and seventy-six eligible pregnant HbSS and HbSC women will be recruited consecutively, randomly assigned to either group and followed from recruitment until delivery. The primary outcome will be the incidence of birth weight below 10th centile for gestational age on INTERGROWTH 21 birth weight charts, or incidence of miscarriage or perinatal death. Secondary outcomes will include PE, maternal death, preterm delivery, perinatal death, number of crises, need for blood transfusion and complications such as infections and placental abruption. Analysis will be by intention to treat and the main treatment effects will be quantified by relative risk with 95% CI, at a 5% significance level.Ethical approvalEthical approval has been granted by the Health Research and Ethics committees of the recruiting hospitals and the National Health Research and Ethics Committee. Study findings will be presented at conferences and published appropriately.Trail registration numberPACTR202001787519553; Pre-results.

scholarly journals Anticardiolipin Positivity Is Highly Associated With Intrauterine Growth Restriction in Women With Antiphospholipid Syndrome

2020 ◽  
Vol 26 ◽  
pp. 107602962097445
Author(s):  
Fangfang Xi ◽  
Yuliang Cai ◽  
Min Lv ◽  
Ying Jiang ◽  
Feifei Zhou ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Intrauterine Growth Restriction ◽  
Low Molecular Weight Heparin ◽  
Low Dose ◽  
Low Molecular Weight ◽  
Intrauterine Growth ◽  
Factors Associated ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Adverse Pregnancy

The purpose of our study was to evaluate pregnancy outcomes of women with antiphospholipid antibodies (aPL) positivity and assess risk factors associated with adverse pregnancy outcomes. Pregnant women with aPL positivity were enrolled prospectively in China from January 2017 to March 2020. Treatment of low-dose aspirin and low molecular weight heparin were given. Pregnancy outcomes and coagulation function were recorded and compared with normal pregnancies. Multivariable logistic regression was performed to identify risk factors associated to intrauterine growth restriction (IUGR). 270 pregnant women, including 44 diagnosed as Antiphospholipid syndrome (APS), 91 as non-criteria APS (NCAPS) and 135 normal cases as control, were enrolled in the study. The live birth rate in aPL carriers and APS group was 97% and 95.5%, respectively. Adverse pregnancy outcomes did not show significant difference between aPL carriers and normal pregnancies, and between APS and NCAPS, except for IUGR. The incidence of IUGR was significantly higher in aPL carriers than normal pregnancies, and in APS patients than NCAPS (P < 0.05). After controlling for age, in vitro fertilization (IVF), pregnancy losses related to APS and treatment, anticardiolipin (aCL) positivity was the only variable significantly associated with IUGR, with an adjusted odds ratio of 4.601 (95% CI, 1.205-17.573). Better pregnant outcomes of aPL positive women, include APS and NCAPS, were achieved in our study with treatment based on low-dose aspirin (LDA) plus low molecular weight heparin (LMWH). The incidence of IUGR was still higher in them, and aCL positivity was the only one risk factor associated with IUGR.

scholarly journals Low dose aspirin and cognitive function in middle aged to elderly adults: randomised controlled trial

BMJ ◽  
2008 ◽  
Vol 337 (sep01 1) ◽  
pp. a1198-a1198 ◽  
Author(s):  
J. F Price ◽  
M. C Stewart ◽  
I. J Deary ◽  
G. D Murray ◽  
P. Sandercock ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Randomised Controlled Trial ◽  
Low Dose ◽  
Controlled Trial ◽  
Elderly Adults ◽  
Middle Aged ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Randomised Controlled

scholarly journals Trial of feasibility and acceptability of routine low-dose aspirin versusEarlyScreeningTest indicated aspirin for pre-eclampsia prevention (TESTstudy): a multicentre randomised controlled trial

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e022056 ◽  
Author(s):  
Fionnuala Mone ◽  
Cecilia Mulcahy ◽  
Peter McParland ◽  
Fionnuala Breathnach ◽  
Paul Downey ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Low Dose ◽  
Controlled Trial ◽  
Low Risk ◽  
Uterine Artery Doppler ◽  
Dose Aspirin ◽  
Nulliparous Women ◽  
Low Dose Aspirin ◽  
Randomised Controlled ◽  
Screening Result

ObjectiveEvaluate the feasibility and acceptability of routine aspirin in low-risk women, compared with screening-test indicated aspirin for the prevention of pre-eclampsia and fetal growth restriction.DesignMulticentre open-label feasibility randomised controlled trial.SettingTwo tertiary maternity hospitals in Dublin, Ireland.Participants546 low-risk nulliparous women completed the study.InterventionsWomen underwent computerised randomisation to: Group 1—routine aspirin 75 mg from 11 until 36 weeks; Group 2—no aspirin and; Group 3—aspirin based on the Fetal Medicine Foundation screening test.Primary and secondary outcome measures(1) Proportion agreeing to participate; (2) compliance with protocol; (3) proportion where first trimester uterine artery Doppler was obtainable and; (4) time taken to issue a screening result. Secondary outcomes included rates of pre-eclampsia and small-for-gestational-age fetuses.Results546 were included in the routine aspirin (n=179), no aspirin (n=183) and screen and treat (n=184) groups. 546 of 1054 were approached (51.8%) and enrolled. Average aspirin adherence was 90%. The uterine artery Doppler was obtained in 98.4% (181/184) and the average time to obtain a screening result was 7.6 (0–26) days. Of those taking aspirin, vaginal spotting was greater; n=29 (15.1%), non-aspirin n=28 (7.9%), OR 2.1 (95% CI 1.2 to 3.6). Postpartum haemorrhage >500 mL was also greater; aspirin n=26 (13.5%), no aspirin n=20 (5.6%), OR 2.6 (95% CI 1.4 to 4.8).ConclusionLow-risk nulliparous women are open to taking aspirin in pregnancy and had high levels of adherence. Aspirin use was associated with greater rates of vaginal bleeding. An appropriately powered randomised controlled trial is now required to address the efficacy and safety of universal low-dose aspirin in low-risk pregnancy compared with a screening approach.Trial registration numberISRCTN (15191778); Post-results.

Pregnancy with Chuvash Polycythaemia and Other Congenital Erythrocytosis

2019 ◽  
Vol 143 (1) ◽  
pp. 69-72 ◽  
Author(s):  
Natacha Dewarrat ◽  
Julie Kaiser ◽  
David Baud ◽  
Lorenzo Alberio ◽  
Mathilde Gavillet
Keyword(s):  
Preterm Birth ◽  
Intrauterine Growth Restriction ◽  
Low Dose ◽  
Thrombotic Event ◽  
First Trimester ◽  
Intrauterine Growth ◽  
Dose Aspirin ◽  
Severe Deficiency ◽  
Low Dose Aspirin ◽  
Original Report

This original report describes the management of a pregnant woman with congenital erythrocytosis (Chuvash polycythaemia) and reviews the scarce data available in the literature. Therapy consisted of low-dose aspirin and phlebotomies to maintain haematocrit <50% while monitoring iron stores to avoid severe deficiency detrimental to the foetus. Despite normal initial foetal growth, the pregnancy was complicated by preterm birth due to chorioamnionitis. The placenta showed no signs of thrombotic events. The published reports cover 13 pregnancies in 8 patients, showing 1 first-trimester miscarriage, 5 infants with intrauterine growth restriction and/or preterm birth and 1 maternal thrombotic event. These cases were managed with phlebotomies, low-dose aspirin and/or low-molecular-weight heparin, although inconsistently.

Sign in / Sign up

Export Citation Format

Share Document