TITRATION OF ANTIPLATELET TREATMENT IN PREGNANT-WOMEN AT RISK OF PREECLAMPSIA

We recruited 111 patients who were considered to be at significantly i ncreased risk of preeclampsia on the basis of previous obstetric histo ry or preexisting medical disorders. All patients were treated with lo w dose aspirin (75 mg/day) from the first occasion the patient attende d the antenatal clinic, regardless of gestational age. If the maternal mean platelet volume (MPV) increased significantly (by > 0.8 fl) from the baseline, antiplatelet treatment was increased. Five pregnancies were lost during the second trimester and 106 of the treated patients had live infants. The incidence of neonatal death (3/106 infants) was much lower than in the previous pregnancies in these patients (32/134 infants). Patients who were treated from the first trimester of pregna ncy (group A, 89 patients) did substantially better than those treated from the second trimester (group B, 17 patients)as assessed by the in cidence of pre-eclampsia or intrauterine growth restriction (IUGR), ge stational age and birthweight at delivery. These data suggest that lon gitudinal monitoring of the MPV may identify the women who could benef it from increased antiplatelet treatment, and that antiplatelet treatm ent may be more effective when initiated in the first trimester rather than later in pregnancy.