Aspirin Again!

As any fan of Downton Abbey knows, preeclampsia can be a killer, as that was Sybil's way of exiting the show a couple of years ago.  Now, as Rick and I talk about on PodMed, a drug that was available then could have helped: aspirin.  That's according to a literature review and recommendations of the USPSTF published this week in Annals of Internal Medicine. What did they find?

First let's take a look at preeclampsia facts.  Worldwide, it claims 12% of the lives of women who die of pregnancy-related causes each year. Serious maternal medical illness is accounted for in one-third of cases by preeclampsia, and 15% of preterm births can also be attributed to the condition. Two to eight percent of pregnancies around the globe are affected, with risk factors including a family history of the condition in mother or sister, advanced maternal age, high BMI, and first pregnancy.

Preeclampsia is defined by a resting blood pressure of 140/90 mmHg or above, with protein spilling into the urine (proteinuria), observed at 20 weeks of gestation or later.  The blood pressure can be much higher, with impairment of cognition and vision, liver and kidney function, and pulmonary edema just some of the profound deleterious consequences. Intrauterine growth retardation also occurs.  The bad news is that once preeclampsia develops the only course of treatment is delivery, with its host of potential negative outcomes depending on development of the fetus. Yikes.  Where's the good news?

This analysis of 15 randomized, controlled trials of daily low-dose aspirin in high-risk pregnant women, along with 8 studies in average-risk women found a reduction in risk of developing preeclampsia of 2-5% and a reduction in intrauterine growth retardation of 1-5%, along with a 2-4% reduction in risk of preterm birth. Small impact, admittedly, but against the magnitude of the problem an outcome worth seeking, we agree.

Dosages of aspirin used in this study varied between 60mg to 150 mg and no short term complications relative to aspirin use were observed. The USPSTF does note however, that no long term studies of the impact of aspirin use during pregnancy on offspring were reported.  Other clear advantages to aspirin are its off-patent status, oral administration, and abundance of experience using it among medical professionals and consumers alike.  Clearly, to address the problem of preeclampsia worldwide a better candidate drug could hardly be dreamed of: cheap, shippable, chemically stable, low abuse potential...the list goes on.

Other topics this week include paternal obesity and autism spectrum disorders in Pediatrics, spironolactone and one form of congestive heart failure in NEJM, and oral therapy for hepatitis C, in the same journal.  Until next week, y'all live well.

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