PDF(Pubmed)
Abstract：
Introduction Pre-eclampsia (PE) is a common diagnosis in pregnancy and affects pregnancies worldwide. Early-onset PE often leads to severe maternal and fetal complications. Prophylactic use of aspirin (150 mg/day) before the 16th week of pregnancy can reduce the risk of PE. This study aimed to investigate the effects of maternal factors on the development of uteroplacental perfusion and fetal biometry from the first to the second trimester in a risk group receiving aspirin prophylaxis compared to a control group without Aspirin. Methods This case-control study included 448 women at high risk for PE (risk group, RG) receiving aspirin prophylaxis and 468 women at low PE risk without aspirin intake (control group, CG). Parameters recorded and considered in the first (T1) and second (T2) trimesters included uterine artery pulsatility multiple of the median (UtAPI MoM), notching at T1 and T2 and fetal biometry parameters at T2. Maternal factors were also captured, and their respective effects were examined. Results UtAPI MoM at T1 and T2 showed a significant positive correlation (r = 0.39, p < 0.001), with UtAPI MoM at T2 significantly higher for notching \"yes\" at T1. Pre-existing arterial hypertension and UtAPI development demonstrated a significant association (p = 0.006). Women without this risk factor showed a significantly (p < 0.001) greater decline in UtAPI development. The likelihood of notching \"yes\" at T2 (p < 0.001; OR: 5.80) was increased with higher UtAPI MoM at T1. The mean values (T1 and T2) of UtAPI MoM were significantly higher in the risk group than in the control group. Patients in the risk group exhibited notching at T2 (p < 0.001; OR: 5.64) more often compared to the control group. The 95% CI of the estimated fetal weight for notching \"yes\" at T1 was below the 50th percentile. Gestational age and head circumference/abdomen circumference (HC/AC) ratio showed a significant negative correlation (p < 0.001; b = -0.01). The control group showed significantly higher estimated fetal weights than the risk group. The HC/AC ratio in the risk group was above the HC/AC ratio in the control group but without proving significance. Conclusions Persistent notching and elevated UtAPI MoM levels in the second trimester may be risk factors for early-onset PE. Women with pre-existing arterial hypertension, notching and elevated UtAPI MoM values in the first and second trimesters require special monitoring during the course of pregnancy.
摘要：
背景技术先兆子痫(PE)是妊娠中的常见诊断并且影响全世界的妊娠。早发性PE通常导致严重的母体和胎儿并发症。在怀孕第16周之前预防性使用阿司匹林（150mg/天）可以降低PE的风险。这项研究旨在研究与不使用阿司匹林的对照组相比，接受阿司匹林预防的风险组从孕早期到孕中期对子宫胎盘灌注和胎儿生物特征的影响。方法本病例对照研究纳入448例PE高危女性(高危人群,RG）接受阿司匹林预防，468名女性在低PE风险而不服用阿司匹林（对照组，CG）。在前三个月（T1）和后三个月（T2）记录和考虑的参数包括子宫动脉搏动倍数中位数（UtAPIMoM），T1和T2的开槽和T2的胎儿生物参数。母体因素也被捕获，并检查了它们各自的效果。结果T1和T2时UtAPIMoM呈显著正相关(r=0.39,p<0.001),在T2处的UtAPIMoM明显更高，用于在T1处开槽“是”。预先存在的动脉高血压和UtAPI发展表现出显著的相关性(p=0.006)。没有这种危险因素的女性在UtAPI发育中表现出显著(p<0.001)更大的下降。随着T1时UtAPIMoM的升高，T2时出现“是”（p<0.001；OR：5.80）的可能性增加。风险组的UtAPIMoM的平均值（T1和T2）显着高于对照组。与对照组相比，风险组的患者在T2时表现出更多的缺口（p<0.001；OR：5.64）。T1时记录“是”的估计胎儿体重的95%CI低于第50百分位数。孕龄与头围/腹围(HC/AC)比值呈显著负相关(p<0.001;b=-0.01)。对照组显示出估计的胎儿体重明显高于风险组。风险组的HC/AC比率高于对照组的HC/AC比率，但无显著性。结论妊娠中期持续缺口和UtAPIMoM水平升高可能是早发性PE的危险因素。有动脉高血压的女性,在第一和第二三个月的开槽和升高的UtAPIMoM值需要在怀孕过程中进行特殊监测。
