Aspirin plus calcium supplementation to prevent superimposed preeclampsia: a randomized trial

Preeclampsia is an important cause of maternal and perinatal morbidity and mortality. Previous studies have tested calcium supplementation and aspirin separately to reduce the incidence of preeclampsia but not the effects of combined supplementation. The objective of this study was to investigate the effectiveness of aspirin combined with calcium supplementation to prevent preeclampsia in women with chronic hypertension. A double-blind, placebo-controlled randomized clinical trial was carried out at the antenatal clinic of a large university hospital in São Paulo, SP, Brazil. A total of 49 women with chronic hypertension and abnormal uterine artery Doppler at 20-27 weeks gestation were randomly assigned to receive placebo (N = 26) or 100 mg aspirin plus 2 g calcium (N = 23) daily until delivery. The main outcome of this pilot study was development of superimposed preeclampsia. Secondary outcomes were fetal growth restriction and preterm birth. The rate of superimposed preeclampsia was 28.6% lower among women receiving aspirin plus calcium than in the placebo group (52.2 vs 73.1%, respectively, P=0.112). The rate of fetal growth restriction was reduced by 80.8% in the supplemented group (25 vs 4.8% in the placebo vs supplemented groups, respectively; P=0.073). The rate of preterm birth was 33.3% in both groups. The combined supplementation of aspirin and calcium starting at 20-27 weeks of gestation produced a nonsignificant decrease in the incidence of superimposed preeclampsia and fetal growth restriction in hypertensive women with abnormal uterine artery Doppler.

Corticoterapia pré-natal nas síndromes hipertensivas da gestaçäo e seus efeitos na pressäo arterial materna / Prenatal corticoid therapy in the hypertensive syndromes of pregnancies and its effects in maternal blood pressure

OBJETIVOS: Avaliar o comportamento da pressäo arterial em gestantes portadoras de síndromes hipertensivas na vigência de ciclo de corticóide (esquema de LIGGINS) utilizado para a aceleraçäo da maturidade pulmonar fetal. MÉTODOS: A partir de estudo retrospectivo, foram avaliadas 27 gestantes portadoras de hipertensäo arterial, com idade gestacional entre 24 e 34 semanas, submetidas a corticoterapia antenatal. Para tanto, foi realizada análise estatística das médias das pressöes arteriais sistólicas e diastólicas separadamente, dos dias anterior, primeiro e segundo dias que compöem o ciclo de corticoterapia e do dia posterior a este ciclo. Obtidas as variâncias, foi aplicado o teste F Statistic, analisado através do valor de p, significante, se menor que 0,05. RESULTADOS: Näo foi observada variaçäo significativa dos níveis de pressäo arterial, seja sistólica como diastólica, näo se identificando dificuldades no controle clínico das pacientes, näo tendo sido observada necessidade de elevaçäo das doses de drogas hipotensores utilizadas. CONCLUSÄO: Nossos resultados observaram segurança na utilizaçäo de ciclos de corticóides em pacientes portadoras de hipertensäo arterial em relaçäo à possíveis agravos dos níveis pressóricos