Clinical and protein correlations of prophylactic treatments for preeclampsia

Abstract

The prophylactic benefit of aspirin in the prevention of preeclampsia is now widely recognized and increasingly utilized. However, its mechanism of action and optimal clinical utility in the prevention of preeclampsia remains a subject of ongoing research. This thesis examined the mechanism of action of aspirin in preventing preeclampsia with specific focus on its anti-inflammatory role, through the 15-epilipoxin-A4, aspirin triggered lipoxin (ATL), pathway. This thesis also examined for the influence of dose of aspirin in pregnancy through a pharmacokinetic assessment, and the influence of inadequate adherence to aspirin on the desired clinical outcomes in high-risk pregnancy. Additionally, this thesis also examined for factors that influenced women's adherence to aspirin in pregnancy. A non-interventional, multi-centre, longitudinal cohort study was prospectively undertaken to achieve the aims of this thesis. In keeping with recent data, this thesis demonstrated that aspirin is an effective prophylactic intervention for preeclampsia amongst high-risk women when adequate adherence is observed. In addition to its known anti-platelet effect, the outcomes of this thesis suggest that aspirin is likely to play a role in placental development through its ATL mediated anti-inflammatory effect in high-risk pregnant women. Additionally, the studies in this thesis also suggest the potential need for aspirin dose adjustment in pregnancy given its altered pharmacokinetic in pregnancy. Importantly, this thesis also demonstrates the importance of adequate adherence with aspirin and emphasizes on the importance of assessment of adherence to aspirin in pregnancy, both in clinical and research settings.

Date of Award	2020
Original language	English