Prophylactic use of aspirin can considerably bring down the incidence of preterm SGA

Use of prophylactic aspirin in high-risk group identified by first trimester screening for preeclampsia would considerably lower the incidence of preterm and early SGA by about 20% and 40%, respectively report the results of a data analysis published July 2018 in ISUOG (International Society of Ultrasound in Obstetrics and Gynecology) journal Ultrasound in Obstetrics and Gynecology.

The researchers analyzed the data from two multicentric trials: Screening program for pre-eclampsia (SPREE) study and the Aspirin for Evidence-Based Preeclampsia Prevention trial (ASPRE). SPREE is a prospective multicenter cohort study that screened women for PE during 11-13 weeks by measuring Mean arterial pressure (MAP), Uterine artery pulsatility index (UtA‐PI), Serum placental growth factor (PlGF), and Serum pregnancy‐associated plasma protein‐A (PAPP‐A).

ASPRE trial examined the prophylactic effect of low-dose aspirin started at 11-14 weeks for prevention of PE in women at increased risk for preterm PE.  The results demonstrated that aspirin reduces the incidence of early-PE by 89% and pre-term PE by 62% but does not much reduce the incidence of term PE.

The combined use of maternal factors mean arterial pressure, uterine artery pulsatility index and serum placental growth factor for the screening for preterm preeclampsia identifies a high proportion of patients who will develop small for gestational age (SGA) babies.

Screening in SPREE trial identified 46% of SGA <10th Percentile neonate born before 37 weeks and 56% of those born before 32 weeks with a screen positive rate of 12.2%. Analysis of data from ASPRE trial showed that aspirin reduced the rate of SGA <10th Percentile by 40% in babies born at or before 37 weeks and by 73% in babies born before 32 weeks.

The decrease in the incidence of SGA infants was mainly due to a substantial decrease in the incidence of PE to the amount of 90% in babies born before 32 weeks and 70% in babies born at or before 37 weeks.

Hence, the authors concluded that first-trimester screening of PE identifies a high proportion of patients with who will develop preterm-SGA as the pregnancy progresses further and the prophylactic use of aspirin can prevent that.

Here is a Video abstract of the above study

Abstract

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History of uterine evacuation is an independent risk factor for preterm birth: a systematic review and meta-analysis.

Preterm birth(PTB) is the birth of an infant before 37 weeks of pregnancy, according to WHO statistics an estimated 15 million babies born preterm out of whom 1 million succumb. PTB is also responsible for long term neurological complications in children like cerebral palsy, learning disabilities and visual and hearing problems.

The current global preterm birth rate is 5% to 18% and statistic shows a steady increase recently.More than 60% of preterm births occur in Africa and South Asia, India topping the list with 3 519 100 PTBs

Three forth of these births could be prevented, saving lives and money across the globe.

CDC data quotes that in the year 2014, every 1 in 10 infants was born preterm in US. For physician across the globe, PTB remains a challenge as the factors leading to preterm births are numerous, complex and not well understood. Among various contributing factors prior uterine surgery, especially those performed on cervix (induced termination of pregnancy (I-TOP) or spontaneous abortion (SAB)) has been implicated in its causation. Studies till now have shown mixed results.

The current research published in May 2016 issue of American Journal of Obstetrics and Gynecology evaluated the risk of PTB in women with a history of uterine evacuation for I-TOP or SAB.

For the data source electronic databases (MEDLINE, Scopus, ClinicalTrials.gov, EMBASE, and Sciencedirect) were searched from their inception until January 2015. Women with prior history of uterine evacuation for either I-TOP or SAB, compared with a control group without a history of uterine evacuation were included in the study.

Total 36 case control studies involving 1,047,683 women (31 studies for I-TOP, 5 studies for SAB) met the inclusion criteria and were included in the analysis.

The primary outcome was relationship between prior evacuation and subsequent preterm births while the secondary outcome studied were low birthweight (LBW) and small for gestational age (SGA). 

Relationship between PTB and prior H/O surgical vs spontaneous evacuation was studied separately and combined both.

The study found that:

• When all procedures combined there were increased odds of having a preterm birth, LBW and SGA babies being born after a history of surgical evacuation.
• Vacuum evacuation and sharp curettage were associated with PTB when analyzed in combination. When analyzing separately sharp curettage was associated with higher risk.
• Medical termination was found quite safe and did not result in PTB in subsequent surgery.
• Women with a prior history of spontaneous abortion(SAB) have a higher risk of PTB, as compared to those with no history of SAB.
• A very important observation as a result of meta-analysis is evacuation before 14 weeks of pregnancy (Spontaneous or induced) was not associated with increased risk for PTB.
• Expectant management of missed abortion is an option with ending in spontaneous loss, but sometimes may end up in heavy bleeding requiring immediate evacuation.

References:

http://www.ncbi.nlm.nih.gov/pubmed/24625129

http://www.ncbi.nlm.nih.gov/pubmed/22682464

http://www.who.int/mediacentre/factsheets/fs363/en/

http://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm