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Zhu J, Gan Y, Yang C, Gu W, Wang Y, Zhang J, Liu Z. In utero aspirin exposure and child neurocognitive development: A propensity score-matched analysis. BJOG 2024. [PMID: 38808468 DOI: 10.1111/1471-0528.17871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE To evaluate the association between a short-period, high-dose in utero aspirin exposure and child neurocognitive development. DESIGN A propensity score-matched analysis of a multicentre prospective cohort study. SETTING The US Collaborative Perinatal Project (1959-1976). POPULATION A total of 50 565 singleton live births with maternal information. METHODS We performed a propensity score matching to balance maternal characteristics between women with and without aspirin exposure. Inverse probability-weighted marginal structural models were used to estimate associations between aspirin exposure and child neurocognitive assessments. MAIN OUTCOME MEASURES Child neurocognitive development was assessed using the Bayley Scales at 8 months, the Stanford Binet Intelligence Scale at 4 years, and the Wechsler Intelligence Scale and Wide-Range Achievement Test (WRAT) at 7 years. RESULTS Children exposed to aspirin in utero were associated with an 8%-16% reduced risk of having suspect/abnormal or below-average scores in most neurocognitive assessments. A trend of lower risks of having suspect/abnormal or below-average scores was further observed in children with in utero aspirin exposure for more than 7 days, particularly on Bayley Mental (relative risk [RR] 0.82, 95% CI 0.74-0.92), WRAT Reading (RR 0.88, 95% CI 0.78-0.98) and WRAT Arithmetic tests (RR 0.76, 95% CI 0.66-0.86). This association was mainly observed in the second trimester of pregnancy. CONCLUSIONS In utero aspirin exposure was associated with improved child neurocognitive development in a prospective cohort study. Further studies are warranted to evaluate the impact of long-period and low-dose in utero aspirin exposure on child short- and long-term neurodevelopment.
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Affiliation(s)
- Jing Zhu
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Yuexin Gan
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Cuiping Yang
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Wei Gu
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Yanlin Wang
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Jun Zhang
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiwei Liu
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
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Joudi N, Rode M. Aspirin in pregnancy: a review of indications, timing, dosing and efficacy. Curr Opin Obstet Gynecol 2023; 35:94-100. [PMID: 36912245 DOI: 10.1097/gco.0000000000000846] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to evaluate the recent literature examining the utility of low-dose daily aspirin (LDA) in the prevention of preeclampsia and other potential adverse perinatal sequelae. The evidence supporting various aspirin doses and timing of initiation of treatment for this purpose will be examined. The potential benefits of LDA therapy in pregnancy will be discussed weighing against any potential associated harm. RECENT FINDINGS Findings from several recent meta-analyses of randomized controlled trials are consistent with prior studies in showing a reduction in risk for preeclampsia with LDA use in individuals at an increased risk for this complication. Some studies suggest aspirin at a dose greater than the current recommended 81 mg is associated with the highest reduction in preterm PE.Several studies have demonstrated a reduction in risk for preterm birth, small for gestational age (SGA) infant or intrauterine growth restriction (IUGR), and a reduction in the risk of perinatal mortality associated with aspirin use. The findings of reduced preterm birth (PTB) and IUGR were also demonstrated among low-risk patients.Identifying patients at risk was re-evaluated, with resulting changes to existing United States Preventive Services Task Force (USPSTF) guidelines. SUMMARY This review of recent evidence suggests a decreased rate of preeclampsia at aspirin doses higher than the standardly used 81 mg when treatment is initiated prior to 16 weeks of gestation. Although LDA use seems promising for other outcomes such as preterm delivery and IUGR, further studies to strengthen recommendations are warranted.
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Affiliation(s)
- Noor Joudi
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University Hospital, Stanford, California, USA
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Ju Y, Feng Y, Yang Y, Hou X, Zhang X, Zhu X, Wang Y, Yang M. Combining curcumin and aspirin ameliorates preeclampsia-like symptoms by inhibiting the placental TLR4/NF-κB signaling pathway in rats. J Obstet Gynaecol Res 2023; 49:128-140. [PMID: 36288911 DOI: 10.1111/jog.15473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 01/19/2023]
Abstract
AIM Preeclampsia (PE) is a common medical complication of pregnancy characterized by high blood pressure and proteinuria after the 20th gestational week. This study aimed to investigate the potency of the combination of curcumin and aspirin in the treatment of PE and explore the underlying mechanisms. MATERIAL AND METHODS The PE model was constructed in female rats by administering 0.5 mg/mL N-nitro-L-arginine methyl ester from gestational days (GDs) 6 to 16. The pregnant female rats were divided into five groups according to the drug treatment. The curcumin or aspirin was given to the rats by tail vein injection (0.36 mg/kg) or gavage treatment (1.5 mg/kg BW/day) from GD4 to GD18. RESULTS Treatment with curcumin and aspirin combination significantly reduced the systolic blood pressure and proteinuria in the PE rats. Meanwhile, in comparison to the PE rats treated with single-dose curcumin or aspirin, the rats treated with combined curcumin and aspirin showed significantly decreased sFlt-1, increased placental growth factor, and alleviated oxidative stress in both blood and placental tissues, which are abnormal in no-treated PE rats. Furthermore, dramatically decreased inflammatory cytokines secretion and TLR4 and NF-κB p65 expression in placental tissues were also observed in the PE rats with combined treatment compared to those of no-treated, signal-dose curcumin or aspirin-treated PE rats. CONCLUSIONS Our results suggested that the combined treatment of curcumin and aspirin significantly ameliorates the symptoms of PE in rats, which is most likely due to the inhibition of the placental TLR4/NF-κB p65 signaling pathway.
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Affiliation(s)
- Yaru Ju
- Perinatal Center, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Yan Feng
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yanjing Yang
- Perinatal Center, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Xiaolin Hou
- Prenatal Diagnostic, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Xiaofeng Zhang
- Department of Obstetrics, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Xihui Zhu
- Perinatal Center, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Yage Wang
- Department of Obstetrics, Gaocheng District Hospital of Traditional Chinese and Western Medicine, Shijiazhuang, China
| | - Meiliu Yang
- Department of Biology, Hengshui University, Hengshui, China
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Landman AJEMC, van Limburg Stirum EVJ, van 't Hooft J, Leemhuis AG, Finken MJJ, van Baar AL, Roseboom TJ, Ravelli ACJ, van Wely M, Oosterlaan J, Painter RC, Pajkrt E, Oudijk MA, de Boer MA. Long-term outcomes following antenatal exposure to low-dose aspirin: study protocol for the 4-year follow-up of the APRIL randomised controlled trial. BMJ Open 2022; 12:e060632. [PMID: 35940829 PMCID: PMC9364408 DOI: 10.1136/bmjopen-2021-060632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The use of low-dose aspirin by pregnant women to prevent preterm pre-eclampsia is gradually increasing. The administration of aspirin during pregnancy improves perinatal outcome, which could translate into improved child outcome in the long term. However, antenatal exposure to aspirin could have adverse effects on child development that may manifest later in life. The aim of this follow-up study is to assess the long-term effects of antenatal exposure to low-dose aspirin compared with placebo on survival, (neuro)development, behaviour and general health at 4 years corrected age. METHODS AND ANALYSIS This is a follow-up study of the Dutch double-blind randomised controlled APRIL trial which assessed the effectiveness of treatment with aspirin (80 mg daily) compared with placebo for the prevention of preterm birth in women with a previous spontaneous preterm birth. Treatment was initiated before 16 weeks of gestation and continued until 36 weeks or birth. We aim to follow-up all 379 children born to women who participated in the APRIL trial and survived the neonatal period, at the corrected age of 4 years. The main outcomes are (neuro)development as assessed by the Ages and Stages Questionnaire, and behaviour as assessed by the Strength and Difficulties Questionnaire. Additional outcomes include mortality, growth and general health from birth up to 4 years, and a composite outcome including mortality, abnormal (neuro)development and problem behaviour. Analyses will be performed by intention-to-treat using a superiority design. ETHICS AND DISSEMINATION Institutional Review Board approval was obtained from the Medical Research Ethics Committee from Amsterdam Medical Center (no. W20 289#20.325). The results will be published in a peer-reviewed journal and presented at conferences. TRIAL REGISTRATION NUMBER The APRIL trial (NTR5675, NL5553; EudraCT number 2015-003220-31) and the APRIL follow-up study (NL8950) are registered in the Dutch trial register. The study is funded by the Amsterdam Reproduction & Development research institute.
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Affiliation(s)
- Anadeijda J E M C Landman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Emilie V J van Limburg Stirum
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Janneke van 't Hooft
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Aleid G Leemhuis
- Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Department of Neonatology and Paediatrics, Meibergdreef 9, Amsterdam, The Netherlands
| | - Martijn J J Finken
- Amsterdam UMC location Vrije Universiteit Amsterdam, Emma Children's Hospital, Department of Paediatric Endocrinology, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Anneloes L van Baar
- Utrecht University, Department of Child and Adolescent Studies, Utrecht, The Netherlands, Utrecht, The Netherlands
| | - Tessa J Roseboom
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Anita C J Ravelli
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef 9, Amsterdam, The Netherlands
| | - Madelon van Wely
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Department of Neonatology and Paediatrics, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Amsterdam UMC Follow-Me program & Emma Neuroscience Group, Meibergdreef 9, Amsterdam, The Netherlands
| | - Rebecca C Painter
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Eva Pajkrt
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Martijn A Oudijk
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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Bovbjerg ML, Tucker CM, Pillai S. Current Resources for Evidence-Based Practice, March 2022. J Obstet Gynecol Neonatal Nurs 2022; 51:225-237. [PMID: 35150643 DOI: 10.1016/j.jogn.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of systemic racism and its effect on maternal health in the United States and commentaries on reviews focused on barriers and facilitators to HPV vaccination and delayed cord clamping in preterm infants.
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