The Role of Aspirin for Preeclampsia Prevention in Women with Diabetes
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DIABETES AND PREGNANCY (M-F HIVERT AND CE POWE, SECTION EDITORS)
The Role of Aspirin for Preeclampsia Prevention in Women with Diabetes Catherine Finnegan 1 & Fionnuala M. Breathnach 1 Accepted: 26 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review A diagnosis of type I or type 2 diabetes confers heightened risk for virtually every obstetric and perinatal complication, with the incidence of superimposed preeclampsia representing a particularly high-risk scenario. Over the past three decades, studies have investigated the role of aspirin in preeclampsia prevention, yielding some promising results for certain atrisk groups, yet unconvincing evidence of benefit among women with pre-pregnancy diabetes. The purpose of this review is to present the current evidence base for aspirin use in pregnancy as a means of mitigating preeclampsia risk in the setting of pregestational type I or type 2 diabetes. Recent Findings Meta-analysis data examining low-dose aspirin for preeclampsia prevention in at-risk and low-risk women has demonstrated modest benefit, but subanalyses of cohorts with diabetes have failed to demonstrate a beneficial effect. Evidence is emerging that indicates a benefit only among women who initiate aspirin therapy prior to 16 weeks’ gestation, and uncertainty exists surrounding the effective dose. Summary In light of equipoise surrounding the potential role of aspirin for prevention of preeclampsia in women with diabetes, current research is targeted at determining clinical efficacy of aspirin in this high-risk obstetric population. Keywords Aspirin . Diabetes mellitus . Preeclampsia . Pregnancy
Introduction Pregestational diabetes, type 1 and type 2, affects 4 per 1000 pregnancies in Ireland. A global increase in the prevalence of diabetes has, however, been observed in recent years. Preexisting diabetes confers a substantial burden of obstetric risk compared to pregnancy among women without diabetes and therefore this condition merits specialist multidisciplinary input before and during pregnancy in order to optimise maternal and neonatal outcomes.
This article is part of the Topical Collection on Diabetes and Pregnancy * Catherine Finnegan [email protected] Fionnuala M. Breathnach [email protected] 1
Royal College of Surgeons in Ireland, Rotunda Hospital, Parnell Square, Dublin 1, Ireland
Preeclampsia is known to occur more commonly in pregnancies complicated by pregestational diabetes, and the consequences of this multisystem disorder may be of greater magnitude in this high-risk obstetric population. This review will explore the role of low-dose aspirin in preeclampsiaprevention among women with type I and type II diabetes.
Preeclampsia Preeclampsia is widely defined as onset of hypertension and proteinuria, with or without associated symptoms, after 20 weeks of gestation. The diagnostic criteria for preeclampsia, as defined by the American College of Obstetricians and Gynecologists, are presented in Table 1. At the earliest oppo
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