Low-dose aspirin in the prevention of preeclampsia and fetal growth retardation: rationale, mechanisms, and clinical trials.
Preeclampsia is characterized by a functional imbalance between vascular prostacyclin and thromboxane A2 production. On the basis of the hypothesis that preeclampsia is at least partially caused by an increase in thromboxane A2, some studies attempted to correct this pathologic condition by pharmacologic manipulation with low-dose aspirin. The current literature suggests that the use of low-dose aspirin during pregnancy is safe with regard to congenital anomalies and fetal, neonatal, and maternal cardiovascular physiologic state and hemostasis. Aspirin at least partially corrects the pathologic increase in angiotensin II sensitivity that precedes the clinical development of preeclampsia. In addition, some clinical trials have demonstrated that low-dose aspirin is effective in reducing the incidence of preeclampsia and/or fetal growth retardation in selected high-risk women. Currently, large clinical trials are in progress to evaluate the effectiveness and side effects of the use of low-dose aspirin in preventing preeclampsia and/or fetal growth retardation. Until these studies have been completed, it will remain unclear whether antiplatelet therapy, such as low-dose aspirin, should be adopted for the prevention of either preeclampsia or fetal growth retardation.
Dekker
G A
GA
Department of Obstetrics and Gynecology, Free University, Amsterdam, The Netherlands.
Sibai
B M
BM
D000804:Angiotensin II / Q000037:antagonists & inhibitors; D001241:Aspirin / Q000008:administration & dosage*; D002986:Clinical Trials as Topic; D011464:Epoprostenol / Q000096:biosynthesis*; D005260:Female; D005317:Fetal Growth Retardation / Q000517:prevention & control*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011225:Pre-Eclampsia / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D011247:Pregnancy / Q000187:drug effects; D013928:Thromboxane A2 / Q000096:biosynthesis*
D010975:Platelet Aggregation Inhibitors; D000804:Angiotensin II; D013928:Thromboxane A2; D011464:Epoprostenol; D001241:Aspirin