Blood pressure assessments of pregnant women in a Day Assessment Unit : a prospective observational study

Aim: We investigated the optimum time and number of observations for assessing women in the Day Assessment Unit. Methods: A single centre prospective observational study was undertaken. Women referred for blood pressure assessment in the Day Assessment Unit were recruited. Results: The blood pressure of women who subsequently developed preeclampsia was noted to change differently over the time of observation compared to women with other hypertensive disorders, most notably in the first and third hour (p¼0.042), although the averages at each hour did not differ between these two groups. Conclusions: Mean blood pressure measured over four hours did not significantly differ compared to blood pressure measured over one hour. Women who subsequently developed preeclampsia had a different pattern of blood pressure change whilst in the Day Assessment Unit

Clinical influence of nonadherence with prophylactic aspirin in preventing preeclampsia in high-risk pregnancies : a multicenter, prospective, observational cohort study

Aspirin nonadherence and its associated increase in cardiovascular and cerebrovascular events is well described; however, the prevalence of aspirin nonadherence among high-risk pregnant women at risk of preeclampsia and its influence on clinical outcomes remains unclear. Our study examined the prevalence of aspirin nonadherence and resistance among high-risk pregnant women quantitatively (platelet function analyzer 100 and plasma salicylic acid) and clinical outcomes relative to adherence. High-risk pregnant women were recruited across 3 centers in the South West Sydney Local Health District. Simultaneous clinic data, blood sample, and self-reported adherence assessment were prospectively collected at 4-week intervals from 12 to 36 weeks of gestation. Nonadherence was defined as normal platelet function analyzer 100 and nondetectable plasma salicylic acid in <90% of time points. Value of <90% is based on current data. Two hundred twenty women were recruited over 25 months. No woman was aspirin resistant, and 63 (44%) women demonstrated inadequate adherence. Women with inadequate adherence had higher incidence of early-onset preeclampsia (17% versus 2%; odds ratio [OR], 1.9 [95% CI, 1.1–8.7]; P=0.04), late-onset preeclampsia (41% versus 5%; OR, 4.2 [95% CI, 1.4–19.8]; P=0.04), intrauterine growth restriction (29% versus 5%; OR, 5.8; [95% CI, 1.2–8.3]; P=0.001), preterm delivery (27% versus 10%; OR, 5.2 [95% CI, 1.5–8.7]; P=0.008), and higher likelihood of increase in antihypertensives antenatally (60% versus 10%; OR, 4.6 [95% CI, 1.2–10.5]; P=0.003). Kaplan-Meier analysis demonstrated lower incidence of premature delivery in the ≥90% adherent group (HR, 0.3 [95% CI, 0.2–0.5]; P<0.001).Kappa coefficient agreement between qualitative and quantitative assessment of adherence was moderate (κ=0.48; SE=0.029; P<0.0001). Our data demonstrates that aspirin is an effective prophylactic agent with an absolute risk reduction of 51% (number needed to treat, 2) when adherence is ≥90%, compared with women with inadequate adherence. Women who were <90% adherent had higher rates of preeclampsia, intrauterine growth restriction, preterm delivery, and increase in antenatal antihypertensive requirements. Self-reported adherence does not accurately reflect actual adherence

The 15-epilipoxin-A4 pathway (ATL) with prophylactic aspirin in preventing preeclampsia : a longitudinal-cohort study

Introduction: The benefit of aspirin in preventing preeclampsia is increasingly recognised, however, its mechanism of action remains unclear. Non-obstetric studies have described an anti-inflammatory effect of aspirin through 15-epilipoxin-A4(ATL). However, the anti-inflammatory mechanism of aspirin in the prevention of preeclampsia remains unknown. Objective/Hypothesis: To examine the (1) difference in longitudinal endogenous lipoxin-A4(EnLipoxin-A4) concentration in low-risk(LR) and high-risk(HR) pregnancies, (2)effect of aspirin on endogenous ATL concentration and the associated effect on cytokine profile of HR women. Methods: Plasma from 220 HR women were collected at 12,16,20,24,28,32 and 36 weeks of gestation. Adherence to aspirin was biochemically verified. Plasma En-Lipoxin-A4 and ATL concentrations were analysed through liquid-chromatography mass-spectrometry(LC-MS/MS) and cytokines;IL-10, TNF-α, IFN-ɣ, IL-8 and IL-1β with high-sensitivity multi-bead Luminex® assay. Results: HR women have up to 70% lower plasma concentration of En-Lipoxin-A4(p<0.001) compared to LR women. HR women with adequate aspirin adherence(HR-AA)(n=82) had higher plasma concentration of ATL(p<0.001), lower concentration of IL-8 from 16-36 weeks of gestation(p<0.001) )and increased IL-10 concentration from 16 – 28 weeks of gestation (p=0.03) in comparison to high-risk women who were not on aspirin(HR-NA). HR-AA who did not develop preeclampsia had higher plasma En-lipoxin-A4(p<0.0001), ATL(p=0.02) and IL-10 concentrations(p<0.001) with lower IL-8 concentration(p=0.004) compared to HR who developed preeclampsia. Discussion: Plasma concentration of En-Lipoxin-A4 is lower in HR women compared to LR controls. Adequate adherence with aspirin results in an increase in ATL and IL-10 with reduced IL-8 plasma concentration. This study suggests a potential anti-inflammatory role of aspirin, through the ATL pathway with prophylactic aspirin in HR pregnant women

Adolescent perinatal outcomes in South West Sydney, Australia

Objective: To compare perinatal outcomes, blood pressures throughout pregnancy, rates of hypertensive disorders of pregnancy, preeclampsia, gestational diabetes mellitus, and immediate obstetric outcomes in adolescents younger than 20 years at delivery and those in the 20- to 34-year age group. Patients and Methods: Questionnaires were administered to pregnant women at Campbelltown and Liverpool hospitals within South West Sydney, Australia, as part of a broader study of sleep-disordered breathing in pregnancy between February 1, 2009, and February 28, 2013. Data collected included demographic data, blood pressure readings, pregnancy complications, delivery type, and neonatal outcomes. Adolescents were compared with older women using Student t tests and c2 statistics. Results: A total of 103 adolescents were compared with 2291 women aged 20 to 34 years. Adolescents were more likely to be primiparous, had longer average gestations, and had lower pre-pregnancy body mass index. Adolescents had lower rates of cesarean section delivery and gestational diabetes mellitus. There was no significant difference in smoking rates, perinatal mortality rate, small for gestational age, intrauterine growth restriction, Apgar score of less than 7 at 5 minutes, admission to special care nursery, or hypertensive disorder of pregnancy rates. Adolescents had lower booking systolic and diastolic blood pressures, and their highest antenatal systolic blood pressures were lower. Conclusion: Adolescents have birth outcomes to similar to those of their older counterparts. Adolescents had lower booking blood pressures. This may have implications for the screening and diagnosis of hypertensive disorders of pregnancy in adolescents

A pharmacokinetic assessment of optimal dosing, preparation and chronotherapy of aspirin in pregnancy

Background: The benefit of aspirin in preventing preeclampsia is well established, however, studies over the years have demonstrated variability in outcomes with its use. Potential contributing factors to this variation in efficacy include dosing, time of dosing and preparation of aspirin Objective(s): We aimed to compare the difference in pharmacokinetics of aspirin, through its major active metabolite, salicylic acid (SA), in pregnant women to non-pregnant women and examine the effect of dose (100mg vs 150mg), preparation (enteric coated (EC) vs non-EC) and chronotherapy of aspirin (morning vs night) between both groups. Study design: Twelve high-risk pregnant women and three non-pregnant women were enrolled into this study. Pregnant women were in one of four groups (100mg EC, 100mg non-EC, 150mg non-EC morning dosing and 150mg non-EC night dosing) whilst non-pregnant women undertook each of the four dosing schedules with at least a 30-day washout period. Blood samples were collected at baseline (pre-ingestion), 1, 2, 4, 6, 12 and 24-hours post-ingestion of aspirin. Plasma obtained was analysed for SA levels through liquid chromatography mass spectrometry (LCMS). Pharmacokinetic values of area under the curve (AUC(t-24)), point of maximum concentration (Cmax), time of maximum concentration (Tmax), volume of distribution (Vd), clearance (CL) and elimination half-life (t½) were analysed for statistical significance with SPSSv25 Results: Pregnant women had a 40% ± 4% reduction in AUC(t-24) (p <0.01) and 29% ± 3% reduction in Cmax (p<0.01) with a 44% ± 8% increase in CL (p<0.01) in comparison to non-pregnant women when 100 mg of aspirin was administered. The reduction in AUC(t-24), however, was minimized with the use of 150mg of aspirin in pregnant women, with which, the AUC(t-24) was closer to that achieved with the use of 100mg aspirin in non-pregnant women. There was a 4-hour delay (p<0.01) in the Tmax, 47% ± 3% reduction in Cmax (p<0.01) and a 48% ± 1% increase in Vd (p<0.01) with the use of 100mg EC aspirin compared to non-EC aspirin with no difference in the overall AUC. There was no difference in the pharmacokinetics of aspirin between morning and night dosing. Conclusion(s): There is a reduction in the total drug metabolite concentration of aspirin in pregnancy and therefore a dose adjustment is potentially required in pregnant women. This is likely due to the altered pharmacokinetics of aspirin in pregnancy with an increase in clearance. There was no difference in the total drug metabolite concentration of aspirin between enteric coated and non-enteric coated aspirin and between morning and night dosing of aspirin. Further pharmacodynamic and clinical studies are required to examine the clinical relevance of these pharmacokinetic findings

Adolescent Perinatal Outcomes in South West Sydney, Australia

Objective: To compare perinatal outcomes, blood pressures throughout pregnancy, rates of hypertensive disorders of pregnancy, preeclampsia, gestational diabetes mellitus, and immediate obstetric outcomes in adolescents younger than 20 years at delivery and those in the 20- to 34-year age group. Patients and Methods: Questionnaires were administered to pregnant women at Campbelltown and Liverpool hospitals within South West Sydney, Australia, as part of a broader study of sleep-disordered breathing in pregnancy between February 1, 2009, and February 28, 2013. Data collected included demographic data, blood pressure readings, pregnancy complications, delivery type, and neonatal outcomes. Adolescents were compared with older women using Student t tests and χ2 statistics. Results: A total of 103 adolescents were compared with 2291 women aged 20 to 34 years. Adolescents were more likely to be primiparous, had longer average gestations, and had lower pre-pregnancy body mass index. Adolescents had lower rates of cesarean section delivery and gestational diabetes mellitus. There was no significant difference in smoking rates, perinatal mortality rate, small for gestational age, intrauterine growth restriction, Apgar score of less than 7 at 5 minutes, admission to special care nursery, or hypertensive disorder of pregnancy rates. Adolescents had lower booking systolic and diastolic blood pressures, and their highest antenatal systolic blood pressures were lower. Conclusion: Adolescents have birth outcomes to similar to those of their older counterparts. Adolescents had lower booking blood pressures. This may have implications for the screening and diagnosis of hypertensive disorders of pregnancy in adolescents