Human Reproduction, Vol 12, 1567-1572, Copyright © 1997 by Oxford University Press
M Tulppala, M Marttunen, V Soderstrom-Anttila, T Foudila, K Ailus, T Palosuo and O Ylikorkala
Early pregnancies in women with a history of recurrent spontaneous abortion
(RSA) are accompanied by a deficiency in vasodilatory and anti- aggregatory
prostacyclin (PGI2) and/or overproduction of its endogenous antagonist
thromboxane A2 (TXA2). We evaluated the effect of a low-dose aspirin (LDA)
on PGI2 and TXA2 production and on pregnancy outcome in RSA women with and
without detectable anticardiolipin antibodies (ACA). Of 82 RSA women
studied, 66 became pregnant, and of them, 33 (six with elevated and 27 with
normal ACA concentrations) were randomized to receive LDA (50 mg/day) and
33 (six with elevated and 27 with normal ACA concentrations) to receive
placebo (PLA) from a mean of 6.6 days after the missed period to delivery.
Treatment with LDA inhibited platelet TXA2 production similarly in RSA
women with and without detectable ACA and with continuing pregnancies (7.0
+/- 0.7 ng/ml, LDA group versus 254.5 +/- 37.8 ng/ml, PLA group, mean +/-
SEM, P < 0.0001) or miscarrying pregnancies (13.8 +/- 3.8 ng/ml compared
with 233.6 +/- 59.8 ng/ml, P < 0.0001 respectively). Furthermore, LDA
decreased urinary excretion of the TXA2 metabolite (2,3-dinor-TXB2) both in
pregnancies which went to term (6.1 +/- 0.6 ng/mmol creatinine, LDA group
versus 19.3 +/- 3.0 ng/mmol creatinine, PLA group, P < 0.0001) or again
ended in miscarriage (4.7 +/- 0.8 ng/mmol creatinine versus 17.3 +/- 4.4
ng/mmol creatinine, P < 0.0001 respectively), but did not affect the
excretion of the prostacyclin metabolite (2,3-dinor-6-keto- PGF1alpha).
Early pregnancy ultrasound examination revealed a living fetus in 58 women.
Of these, seven in the LDA group (23.3%, four with elevated and three with
normal ACA concentrations) and five in the PLA group (17.9%, two with
elevated and three with normal ACA concentrations; not significant)
experienced a miscarriage. All infants were healthy, and the frequency of
growth retardation was similar in both groups (13.0%). One woman in the LDA
group (4.3%) and three women receiving PLA (13.0%) developed pre-eclampsia
(not significant). Therefore, although treatment with LDA caused a
desirable biochemical effect, it did not improve pregnancy outcome in RSA
women with or without detectable ACA.
ARTICLES
Low-dose aspirin in prevention of miscarriage in women with unexplained or autoimmune related recurrent miscarriage: effect on prostacyclin and thromboxane A2 production
Department of Obstetrics and Gynaecology, University Central Hospital of Helsinki, Finland.
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