Managing High-Risk Pregnancy: The Role of Low-Dose Aspirin and Calcium Supplementation
This article discusses the impact of high body mass index (BMI > 30) on pregnancy, increasing risks such as preeclampsia, gestational diabetes, and fetal macrosomia. It emphasizes the benefits of low-dose aspirin in mitigating these risks due to its effects on vasodilators and eicosanoids. Recommendations for aspirin use after risk assessment and close monitoring during the second trimester are provided. Additionally, the significance of high-dose calcium supplementation is highlighted, including its role in controlling hypertension and promoting smooth muscle relaxation.
Managing High-Risk Pregnancy: The Role of Low-Dose Aspirin and Calcium Supplementation
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Presentation Transcript
BMI and Diet • Augmented placental production of leptin, adinopectin, TAG, and inflammation • BMI>30 increases risk of: • Preeclampsia • Gestational diabetes • Fetal macrosomia
Low Dose Aspirin • Based on a functional imbalance between vasodilator and vasoconstrictor eicosanoids. • TXL-A2 increased and PGI levels decreased • Aspirin- inhibits TX-A2 while PGI can be resynthesized from the endothelium.
Low Dose Aspirin • Can be given provided that: • Have identified risk based on previous history of hypertension, adverse obstetric outcomes, MAP or roll over tests, abnormal doppler waveforms or angiotensin sensitivity tests • No history of aspirin allergy or hypersensitivity • Started on 2nd trimester • Doses lept at 60-80 mg/day • Platelet and coagulation profiles are monitored. • Fetal DuctusArteriosus and urine production/AF volume are monitored.
High Dose Calcium: 2 gram/day High dose Ca (-) PTH Intracellular Ca Smooth muscle relaxation Response to pressor stimuli
High Dose Calcium: 2 gram/day • Ca supplement: -higher level of Ca excretion - increased levels of serum Mg -smooth muscle relaxation in BV -Control of HPN
Anti-Oxidant Therapy • Not recommended
