What does this research mean for the field?

Low-dose aspirin (100 mg/d) ingested at bedtime, but not upon awakening, significantly reduces ambulatory blood pressure and the incidence of adverse pregnancy outcomes such as preeclampsia when initiated at or before 16 weeks of gestation. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine whether the administration timing (chronotherapy) of low-dose aspirin modulates blood pressure and reduces complications in high-risk pregnant women.

September 24, 2012Chronobiology InternationalOpen Access

Chronotherapy With Low-Dose Aspirin for Prevention of Complications in Pregnancy

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Why the study?

Does chronotherapy with low-dose aspirin (100 mg/d) reduce ambulatory blood pressure and the incidence of serious adverse pregnancy outcomes in high-risk pregnant women?

Key Points

To determine whether the administration timing (chronotherapy) of low-dose aspirin modulates blood pressure and reduces complications in high-risk pregnant women.
A prospective, randomized, double-blind, placebo-controlled trial recruited 350 high-risk pregnant women (183 nulliparous; mean age 30.7 years; 13.5 weeks gestation).
Participants were assigned to receive 100 mg/day aspirin or placebo at one of three administration times: upon awakening, 8 hours after awakening, or at bedtime, started at 12–16 weeks gestation until delivery.
Blood pressure was tracked using 48-hour ambulatory blood pressure monitoring every 2–4 weeks throughout gestation and at puerperium.
Low-dose aspirin significantly decreased the composite risk of preeclampsia, preterm delivery, intrauterine growth retardation (IUGR), and stillbirth compared with placebo (HR 0.35, 95% CI 0.22–0.56, p < 0.001).
Blood pressure reduction was highly dependent on timing, showing no benefit upon awakening but significant reduction at bedtime (p < 0.001); bedtime/evening aspirin also yielded lower composite adverse events than awakening aspirin or placebo (HR 0.19, 95% CI 0.10–0.39, p < 0.001).
Aspirin was not associated with an increased risk of pre- or post-delivery hemorrhage relative to placebo (HR 0.57, 95% CI 0.25–1.33, p = 0.194).

Structured PICO

Does chronotherapy with low-dose aspirin (100 mg/d) reduce ambulatory blood pressure and the incidence of serious adverse pregnancy outcomes in high-risk pregnant women?

Population

350 high-risk pregnant women (183 nulliparous), mean age 30.7 ± 5.3 years, at 13.5 ± 1.4 weeks of gestation at the time of recruitment.

Intervention

Aspirin 100 mg/d administered upon awakening, 8 h after awakening, or at bedtime, starting at 12-16 weeks of gestation and continuing until delivery.

Comparator

Placebo administered upon awakening, 8 h after awakening, or at bedtime.

Outcome

Composite of serious adverse outcomes (preeclampsia, preterm delivery, intrauterine growth retardation [IUGR], and stillbirth) and ambulatory blood pressure.composite

Discussion

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Implication

Bedtime low-dose aspirin may be preferred in high-risk pregnancies; extends chronotherapy evidence to obstetrics.

Cite This Study

Ayala et al. (2012) studied this question.

synapsesocial.com/papers/6a198ef2e7f8932c5eea658f https://doi.org/10.3109/07420528.2012.717455

Topics

Dual antiplatelet therapy

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Chronotherapy With Low-Dose Aspirin for Prevention of Complications in Pregnancy

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Chronotherapy With Low-Dose Aspirin for Prevention of Complications in Pregnancy

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

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