Low-dose aspirin may help new mothers cut preterm birth risk

Daily low-dose aspirin, from as early as the sixth week of pregnancy through the 36th week, may lower the risk of preterm birth among first-time mothers, suggest the results of a clinical trial which involved women from several low and middle-income countries, including India.

The study, published in the journal The Lancet, involved more than 11,000 women.

The results showed that women taking daily low-dose aspirin were 11 per cent less likely to deliver before the 37th week of pregnancy, compared to those given a placebo.

"Our results suggest that low-dose aspirin therapy in early pregnancy could provide an inexpensive way to lower the preterm birth rate in first-time mothers," said study author Marion Koso-Thomas of the US National Institutes of Health's Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

Preterm birth is the most common cause of infant death and the leading cause of long-term neurological disability in children.

According to the study authors, advances in newborn care have improved survival for preterm infants, but this care is limited or unavailable in many parts of the world.

Earlier studies have suggested that low-dose aspirin may reduce the risk of preterm birth and pre-eclampsia, a potentially life-threatening blood pressure disorder of pregnancy.

However, these studies were not large enough to statistically determine the therapy's effectiveness in reducing preterm birth.

The researchers enrolled 11,976 women with a first-time pregnancy from seven sites in India, Pakistan, Zambia, Democratic Republic of the Congo, Guatemala and Kenya.

Roughly half were assigned at random to receive 81 milligrams of aspirin daily; the other group received a daily placebo. Women were included in the study only if they maintained a pregnancy for more than 20 weeks.

Preterm birth (before 37 weeks) occurred in 11.6 per cent of the women who took aspirin and in 13.1 per cent of the women who took the placebo.

Similarly, birth before 34 weeks (early preterm delivery) occurred in 3.3 per cent of the aspirin group and 4 per cent of the placebo group (a 25 per cent reduction).

Women in the aspirin group also had a lower rate of perinatal mortality (stillbirth or newborn death in the first seven days of life), compared to the placebo group (45.7 per 1,000 births vs 53.6 per 1,000 births).

The risk of high blood pressure disorders of pregnancy at term did not differ significantly between the groups.

The low cost and safety of low-dose aspirin therapy suggests that it could be easily adapted for wide-scale use, suggested the study authors.

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Pre-eclampsia can affect pregnant woman’s heart

A recent study indicated that pre-eclampsia, a potentially dangerous condition characterised by high blood pressure in pregnant women also have effects on cardiovascular health that may persist well even after pregnancy.

According to the study researcher's analysis included 13 studies that measured cardiac function by trans-thoracic echo-cardiography between 6 months and 18 years following a pregnancy complicated by pre-eclampsia.

"Pre-eclampsia is a real-life 'stress test' and the use of trans-thoracic echo-cardiography could help us detect early consequences on the heart before women experience symptoms," said co-author.

However, more studies are needed to determine whether long-term cardiovascular screening might benefit women with a history of pre-eclampsia.

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Blood test can help diagnose pre-eclampsia

A simple blood test can help diagnose a common but potentially fatal pregnancy complication- pre-eclampsia, finds a study.

During the study, by measuring the concentration of placental growth factor (PIGF) in a woman's blood, doctors were able to diagnose pre-eclampsia 2 days sooner on average.

" We knew monitoring PIGF was an accurate way to help detect the condition but were unsure whether making this tool available to clinicians would lead to better care for women. Now we know that it does," said the lead author.

Pre-eclampsia, a condition in pregnancy characterised by high blood pressure, sometimes with fluid retention and proteinuria, can cause damage to vital organs, fits and can be fatal for the woman and baby, if left untreated. Globally, 100 women die due to pre-eclampsia every day.

" For the last 100 years, we've diagnosed pre-eclampsia by measuring blood pressure and checking for protein in a woman's urine. These are relatively imprecise and often quite subjective, he noted.

For the study, the research team studies 1,035 women with suspected pre-eclampsia from 11 maternity units across UK. They're randomly assigned to 2 groups= 1 had their PIGF test results made available to their clinical team, the other did not.

The PIGF testing was shown to reduce the average time to diagnose pre-eclampsia from 4-2 days and serious complications before birth ( such as eclampsia, stroke and maternal death) to 4 % from 5 %.

There was no change in the likelihood of complications for the baby, the age at which babies were delivered prematurely or whether they're admitted to a neonatal unit, the researchers said.

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Stroke risk factors unique to women identified

Stroke disproportionately affects more women than men. It is the third leading cause of death in women in the United States, is a leading cause of disability and affects 55,000 more women than men each year. Investigators are exploring the effects of potential risk factors that are unique to women, including hormone levels, hormone therapy, hormonal birth control, pregnancy and time of menarche and menopause. In a paper this week as part of a special issue focused on women's health in honor of the American Heart Association's Go Red month, the team highlights risk factors with strong support in the scientific literature as well as important areas where future research needed, including the effects of hormone therapies for transgender people.

"Many people don't realize that women suffer stroke more frequently than men, and mortality is much higher among women. As women age, they are much more likely to have a stroke as a first manifestation of cardiovascular disease rather than heart attack," said a Dr. "We want to better understand susceptibility: why do more women have strokes than men? What factors are contributing and disproportionately increasing women's risk?"

The team that delved into the scientific literature to investigate evidence about risk factors that are unique to women. The co-author of the report on several factors that elevate stroke risk among women including:

• Early age of menarche (less than 10 years old)
• Early age at menopause (less than 45 years old)
• Low levels of the hormone dehydroepiandrosterone (DHEAS)
• Taking oral estrogen or combined oral contraceptives

The team notes that while many of these factors are extremely common - only a fraction of women who have one or more will have a stroke in their lifetimes. However, the author emphasizes that it is important for clinicians to consider these factors and others - including women who have a history of pregnancy complications including gestational diabetes, pre-eclampsia or hypertension during or immediately following pregnancy.

"These women should be monitored carefully and they should be aware that they are at higher risk, and motivated to adhere to the healthiest lifestyle behaviors to decrease the risk of hypertension and subsequent stroke," the author said.

Certain risk factors - such as taking transdermal estrogen or progestogen-only contraception - need further research, according to the authors. The team also conducted a search of the literature for studies on stroke risk factors unique to transgender people, but report that data on the effects medical treatment with estrogens, anti-androgens, or a combination of both is scant. Research on how to decrease risk among women with a history of pregnancy complication is another area ripe for additional research.

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Drinking probiotic milk may bring down risk of pregnancy complications

Pregnant women who drink milk containing probiotic “friendly” bacteria are less likely to have premature births or pre-eclampsia, a serious complication of pregnancy, suggests a study.

Timing was everything, though, researchers found: Women who drank probiotic milk early in their pregnancies, but not those who only drank it before or late in pregnancy, were 21 percent less likely to give birth prematurely compared to others. For pre-eclampsia, a 20 percent risk reduction went along with drinking probiotic milk late in pregnancy, but not earlier in gestation or before getting pregnant.

“Since pregnancy is a time of rapid change and different exposures can have different effect depending on the time of exposure, we wanted to find out if there is any special time point of consumption that might be of greater importance when it comes to these associations,” lead author wrote in an email.

These findings are only statistical observations, they do not prove causality and are therefore not enough to start recommending probiotic consumption to pregnant women, said  a researcher.

But, she added, “Consumption of probiotic milk products during early pregnancy might lower the risk of preterm delivery, and consumption during the other half of pregnancy might reduce the risk of preeclampsia.”

The team examined data on more than 70,000 pregnancies in a country. Participating mothers-to-be were recruited for a larger long-term study between 1999 and 2008, and followed through pregnancy and beyond.

The pregnant women included in the analysis, all first-time mothers, provided information on their diet, medical history and other relevant background and lifestyle factors at 15, 22 and 30 weeks’ gestation.

At about 15 and 30 weeks, the questions included additional information on intake of milk containing probiotic bacteria before and during pregnancy.

Nearly one in four women said they had consumed probiotic milk before pregnancy, while about one third drank it early in pregnancy and another third had it during the later part of their pregnancies.

On average, drinking probiotic milk was more common among older, more affluent and better-educated women who didn’t smoke and took dietary supplements, the researchers report in the journal.

Among 37,000 women included in the pre-eclampsia analysis, about 5 percent were diagnosed with the condition, with 550 of cases classified as severe. Pre-eclampsia, sometimes known as toxemia, is a syndrome that typically occurs after the 20th week of pregnancy and its hallmarks include high blood pressure, swelling of hands and feet, protein in the urine and sometimes kidney or liver problems.

The reduced risk of pre-eclampsia associated with drinking probiotic milk later in pregnancy was only statistically meaningful for the severe form of the condition, researchers note.

More than 34,000 women were included in the premature birth analysis, and a total of 2,858 babies were born early. The protective effect linked to early-pregnancy probiotic milk consumption was most significant for “late” pre-term births, that is, after 34 weeks of pregnancy but before the full term of 39-40 weeks.

“What preeclampsia and preterm delivery have in common is that both come with a higher degree of inflammation in the body than what you would expect in a normal pregnancy,” the researcher said.
Probiotics might be able to reduce inflammation and therefore these related risks, but more research is needed, she said.

“I think they did a really good job in presenting the evidence in a very cautious, guarded, measured way, and they say, ‘this is an opportunity,’ basically, ‘but let’s look at this very carefully and from a prophylactic perspective’,” said a Dr.

No claims can be made about probiotic use for preventing these pregnancy complications at this time, he cautioned. “I think it’s an interesting observation, this whole realm of probiotics. And I think in a guarded way they’ve done a very good job,” said the Dr. who wasn’t involved in the study.

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