Impact of the ACOG guideline regarding low-dose aspirin for prevention of superimposed preeclampsia in women with chronic hypertension.
Adult
Aspirin
/ administration & dosage
Cohort Studies
Female
Humans
Hypertension
Incidence
Philadelphia
/ epidemiology
Platelet Aggregation Inhibitors
/ administration & dosage
Practice Guidelines as Topic
Pre-Eclampsia
/ epidemiology
Pregnancy
Pregnancy Trimester, First
Prenatal Care
/ standards
Retrospective Studies
Societies, Medical
ACOG
aspirin
chronic hypertension
low-dose aspirin
preeclampsia
preterm birth
small for gestational age
superimposed preeclampsia
Journal
American journal of obstetrics and gynecology
ISSN: 1097-6868
Titre abrégé: Am J Obstet Gynecol
Pays: United States
ID NLM: 0370476
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
24
06
2019
revised:
28
02
2020
accepted:
03
03
2020
pubmed:
17
3
2020
medline:
18
11
2020
entrez:
17
3
2020
Statut:
ppublish
Résumé
Patients with chronic hypertension are at increased risk for superimposed preeclampsia. The 2016 American College of Obstetricians and Gynecologists guideline recommended initiating 81 mg of daily aspirin for all pregnant women with chronic hypertension to prevent superimposed preeclampsia. (1) To evaluate the rates of implementation of the 2016 American College of Obstetricians and Gynecologists guideline over time; and (2) to evaluate the effectiveness of aspirin for the prevention of superimposed preeclampsia and other adverse maternal and neonatal outcomes in women with chronic hypertension before and after this guideline. This is a retrospective study of women with chronic hypertension who delivered at Thomas Jefferson University Hospital from January 2014 through June 2018. This cohort of women with chronic hypertension was divided into 2 groups, before and after the American College of Obstetricians and Gynecologists recommendation published in September 2016. Daily 81 mg of aspirin was initiated between 12 and 16 weeks. We excluded multiple gestations and incomplete records. The primary outcome was incidence of superimposed preeclampsia, and secondary outcomes were incidence of superimposed preeclampsia with or without severe features, small for gestational age, and preterm birth <37 weeks. Subgroup analysis based on risk stratification was evaluated in women with chronic hypertension requiring antihypertensive medication, history of preeclampsia, and pregestational diabetes. We identified 457 pregnant women with chronic hypertension, 203 in the post-American College of Obstetricians and Gynecologists group and 254 in the pre-American College of Obstetricians and Gynecologists group. Aspirin 81 mg was offered to 142 (70%) in the post-American College of Obstetricians and Gynecologists group and 18 (7.0%) in the pre-American College of Obstetricians and Gynecologists group. Maternal demographics were not significantly different. The overall incidence of superimposed preeclampsia was not significantly different: 87 (34.3%) vs 72 (35.5%), P=.79, in the pre- and post-American College of Obstetricians and Gynecologists guideline groups, respectively. Superimposed preeclampsia with severe features significantly increased: 32 (12.6%) vs 9 (4.4%), P<.01, whereas superimposed preeclampsia without severe features significantly decreased: 55 (21.7%) vs 63 (31.0%), P=.03. There were no significant differences in small for gestational age neonates or preterm birth <37 weeks incidences between groups. There were no significant differences in the subgroup analysis based on the severity of chronic hypertension requiring antihypertensive medication, history of preeclampsia, or pregestational diabetes. After the adoption of the American College of Obstetricians and Gynecologists guidelines in 70% of the cohort, superimposed preeclampsia, small for gestational age, and preterm birth were not significantly decreased after implementation of aspirin 81 mg initiated between 12 and 16 weeks of gestation.
Sections du résumé
BACKGROUND
Patients with chronic hypertension are at increased risk for superimposed preeclampsia. The 2016 American College of Obstetricians and Gynecologists guideline recommended initiating 81 mg of daily aspirin for all pregnant women with chronic hypertension to prevent superimposed preeclampsia.
OBJECTIVE
(1) To evaluate the rates of implementation of the 2016 American College of Obstetricians and Gynecologists guideline over time; and (2) to evaluate the effectiveness of aspirin for the prevention of superimposed preeclampsia and other adverse maternal and neonatal outcomes in women with chronic hypertension before and after this guideline.
STUDY DESIGN
This is a retrospective study of women with chronic hypertension who delivered at Thomas Jefferson University Hospital from January 2014 through June 2018. This cohort of women with chronic hypertension was divided into 2 groups, before and after the American College of Obstetricians and Gynecologists recommendation published in September 2016. Daily 81 mg of aspirin was initiated between 12 and 16 weeks. We excluded multiple gestations and incomplete records. The primary outcome was incidence of superimposed preeclampsia, and secondary outcomes were incidence of superimposed preeclampsia with or without severe features, small for gestational age, and preterm birth <37 weeks. Subgroup analysis based on risk stratification was evaluated in women with chronic hypertension requiring antihypertensive medication, history of preeclampsia, and pregestational diabetes.
RESULTS
We identified 457 pregnant women with chronic hypertension, 203 in the post-American College of Obstetricians and Gynecologists group and 254 in the pre-American College of Obstetricians and Gynecologists group. Aspirin 81 mg was offered to 142 (70%) in the post-American College of Obstetricians and Gynecologists group and 18 (7.0%) in the pre-American College of Obstetricians and Gynecologists group. Maternal demographics were not significantly different. The overall incidence of superimposed preeclampsia was not significantly different: 87 (34.3%) vs 72 (35.5%), P=.79, in the pre- and post-American College of Obstetricians and Gynecologists guideline groups, respectively. Superimposed preeclampsia with severe features significantly increased: 32 (12.6%) vs 9 (4.4%), P<.01, whereas superimposed preeclampsia without severe features significantly decreased: 55 (21.7%) vs 63 (31.0%), P=.03. There were no significant differences in small for gestational age neonates or preterm birth <37 weeks incidences between groups. There were no significant differences in the subgroup analysis based on the severity of chronic hypertension requiring antihypertensive medication, history of preeclampsia, or pregestational diabetes.
CONCLUSION
After the adoption of the American College of Obstetricians and Gynecologists guidelines in 70% of the cohort, superimposed preeclampsia, small for gestational age, and preterm birth were not significantly decreased after implementation of aspirin 81 mg initiated between 12 and 16 weeks of gestation.
Identifiants
pubmed: 32173446
pii: S0002-9378(20)30322-7
doi: 10.1016/j.ajog.2020.03.004
pmc: PMC8299295
mid: NIHMS1662640
pii:
doi:
Substances chimiques
Platelet Aggregation Inhibitors
0
Aspirin
R16CO5Y76E
Types de publication
Journal Article
Practice Guideline
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
419.e1-419.e16Subventions
Organisme : NIGMS NIH HHS
ID : T32 GM008562
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
Références
J Perinat Med. 2018 Sep 25;46(7):776-779
pubmed: 29381473
Ultrasound Obstet Gynecol. 2017 Jun;49(6):751-755
pubmed: 28067011
Am J Obstet Gynecol. 1998 Nov;179(5):1359-75
pubmed: 9822529
Aust N Z J Obstet Gynaecol. 2015 Feb;55(1):11-6
pubmed: 25308532
Cochrane Database Syst Rev. 2007 Apr 18;(2):CD004659
pubmed: 17443552
Hypertension. 1997 Sep;30(3 Pt 2):589-95
pubmed: 9322987
N Engl J Med. 1989 Aug 10;321(6):357-62
pubmed: 2664523
Ultrasound Obstet Gynecol. 2017 Jun;49(6):756-760
pubmed: 28295782
Lancet Glob Health. 2014 Jun;2(6):e323-33
pubmed: 25103301
Radiology. 1991 Oct;181(1):129-33
pubmed: 1887021
Adv Pharmacol. 2016;77:361-431
pubmed: 27451103
Pregnancy Hypertens. 2014 Apr;4(2):105-45
pubmed: 26104418
Lancet. 2020 Jan 25;395(10220):285-293
pubmed: 31982074
Ultrasound Obstet Gynecol. 2015 Oct;46(4):414-8
pubmed: 25914193
N Engl J Med. 2017 Aug 17;377(7):613-622
pubmed: 28657417
BMC Pediatr. 2013 Apr 20;13:59
pubmed: 23601190
Placenta. 1983 Oct-Dec;4(4):397-413
pubmed: 6634666
BJOG. 2013 Jan;120(1):64-74
pubmed: 23126307
Am J Obstet Gynecol. 2018 Mar;218(3):287-293.e1
pubmed: 29138036
BJOG. 2002 Feb;109(2):161-7
pubmed: 11888098
Cochrane Database Syst Rev. 2014 Feb 06;(2):CD002252
pubmed: 24504933
Ann Intern Med. 2014 May 20;160(10):695-703
pubmed: 24711050
Am J Obstet Gynecol. 2020 May;222(5):437-450
pubmed: 31494125
Hypertension. 2008 Apr;51(4):1002-9
pubmed: 18259010
Am J Obstet Gynecol. 2018 Jan;218(1):126.e1-126.e13
pubmed: 29097177
Angew Chem Int Ed Engl. 2012 Oct 8;51(41):10359-63
pubmed: 22965929
Am J Obstet Gynecol. 2015 May;212(5):624.e1-17
pubmed: 25582098
Int J Gynaecol Obstet. 2019 May;145 Suppl 1:1-33
pubmed: 31111484
Br J Obstet Gynaecol. 1993 Sep;100(9):809-15
pubmed: 8217999
Am J Obstet Gynecol. 2015 Oct;213(4 Suppl):S115-22
pubmed: 26428489
Am J Obstet Gynecol. 2017 Feb;216(2):121-128.e2
pubmed: 27810551
Lancet. 2014 Jul 5;384(9937):29-36
pubmed: 24702835
Ultrasound Obstet Gynecol. 2015 Oct;46(4):419-23
pubmed: 25678383
J Reprod Immunol. 2019 Sep;134-135:1-10
pubmed: 31301487
Fertil Steril. 1999 May;71(5):825-9
pubmed: 10231040
Lancet. 1994 Mar 12;343(8898):619-29
pubmed: 7906809
J Clin Endocrinol Metab. 2017 May 1;102(5):1495-1504
pubmed: 28323989
Int J Gynaecol Obstet. 1998 Feb;60(2):129-35
pubmed: 9509950
Obstet Gynecol. 2016 Apr;127(4):689-698
pubmed: 26959198
Chronobiol Int. 2013 Mar;30(1-2):260-79
pubmed: 23004922
BMJ. 2019 Jul 15;366:l2381
pubmed: 31307997
Proc Soc Exp Biol Med. 1999 Dec;222(3):222-35
pubmed: 10601881
Am J Obstet Gynecol. 2017 Nov;217(5):585.e1-585.e5
pubmed: 28784417
Obstet Gynecol. 2016 Aug;128(2):270-276
pubmed: 27400013
Hypertens Pregnancy. 2017 May;36(2):226-231
pubmed: 28541800
Br J Obstet Gynaecol. 1996 Jan;103(1):39-47
pubmed: 8608096
Obstet Gynecol. 2013 Nov;122(5):1122-1131
pubmed: 24150027
Am J Obstet Gynecol. 2019 Sep;221(3):255.e1-255.e9
pubmed: 31051121
Lancet. 2007 May 26;369(9575):1791-1798
pubmed: 17512048
N Engl J Med. 1998 Mar 12;338(11):701-5
pubmed: 9494145
Am J Obstet Gynecol. 2017 Feb;216(2):110-120.e6
pubmed: 27640943
Croat Med J. 2005 Oct;46(5):826-31
pubmed: 16158479
Clin Pharmacokinet. 2018 Jun;57(6):663-672
pubmed: 29139042
Obstet Gynecol. 2018 Jul;132(1):e44-e52
pubmed: 29939940
Nat Rev Nephrol. 2014 Aug;10(8):466-80
pubmed: 25003615
Am J Obstet Gynecol. 2019 Apr;220(4):385.e1-385.e6
pubmed: 30786253
Obstet Gynecol. 2010 Aug;116(2 Pt 1):402-414
pubmed: 20664402
Ultrasound Obstet Gynecol. 2000 Jan;15(1):19-27
pubmed: 10776008
Fetal Diagn Ther. 2013;33(1):8-15
pubmed: 22906914
Am J Obstet Gynecol. 2019 Dec;221(6):650.e1-650.e16
pubmed: 31589866
Placenta. 2009 Mar;30 Suppl A:S43-8
pubmed: 19081132
Nat Rev Nephrol. 2014 Sep;10(9):531-40
pubmed: 25003612
Am J Obstet Gynecol. 2016 Jan;214(1):103.e1-103.e12
pubmed: 26297382