Pre-Eclampsia Clinical Trial
Official title:
Prevention of Preeclampsia With Aspirin Administered From the Beginning of Pregnancy in Recipients of Donated Oocytes.
The main objective of this trial is to study the occurrence of preeclampsia in recipients of donated oocytes receiving aspirin at an early stage during pregnancy and to compare the results with those obtained in patients receiving placebo.
Various markers have been proposed for the early diagnosis of preeclampsia: determination of
mean arterial pressure; presence of multiple risk factors of preeclampsia; biochemical,
ultrasound, and angiogenic markers; uterine artery Doppler, etc. These are used to
determinate which patients have an increased risk of developing preeclampsia during
gestation, and therefore carry out closer monitoring of pregnancy in this population. In
addition, these markers can also identify patients at increased risk of developing other
problems such as IUGR or preterm labor.
For nearly 30 years, there have been multiple studies trying to demonstrate that aspirin
prevents the onset of preeclampsia with inconclusive results. However, recent studies in
which aspirin was administered at an early stage (before 16 weeks of gestation) in patients
at high risk of complications, have demonstrated a decrease in the incidence of this entity.
Thus, administration of aspirin to patients at high risk (patients classified with a high
risk of complications during pregnancy, based on markers mentioned above) seems to be useful
in preventing onset of preeclampsia, IUGR and other complications, whenever it is
administered at an early stage, as shown by several studies carried out so far.
The incidence of preeclampsia, IUGR and other complications of pregnancy is increased in
patients undergoing treatment for ovulation induction, being much higher in recipients of
donated oocytes. It appears that this increase may be explained by immunological processes.
The focus lies on the interaction between HLA-C fetal antigen with the maternal natural
killer cells. We postulate, therefore, that the administration of aspirin in recipients of
donated oocytes at an early stage of pregnancy, may also reduce the incidence of preeclampsia
in this group of patients.
Moreover, it has been observed that patients with preeclampsia exhibit lower levels of VEGF,
PlGF and PAPP-A (factors involved in placental angiogenesis) and that this is accompanied by
an increase in the sFlt1 (a potent PIGF and VEGF antagonist).
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