factor such as hypdipidemia or in- creased cardiac output

Commentary

Recently, some health care providers have adopted the use of prophylactic therapies such as lowdose aspirin and calcium supplementation for the prevention of preeclampsia. This ap preach may become more justified ii a population can be identified that

may benefit from the therapies. This would also be most beneficial ii the risk group could commence with tbeii prophylaxis before 36 weeks’ gestation, at which time the major portion of maternal and prenatal morbidity and mortal@ MCW imm

tbii dii This study can be criticized mainiy

for two issues. the first of which is wsearchers~ finding that nuUipadty was not found to be a significant iac- tar in developing preecfampsia. The study failed to provide paternity in- fw&ion; for &ample, a woman considered multirnrous in this study group may have become pwgn&t v,i!h a new partner. thereby making her ‘?mmun&g!aUy equivalent to a nulliparous woman.” The second p&t is that in evaluating c&ah7 iac- ton from inclusion in the study gm”P. “older” Ihome” with essenti

why the& was no correlation be- tween advanced maternal age and the diagnosis of were preeclampsia.

As midwives, we know that an im- portant facet of our care Is in screen- ing abnonnalftks as part of caring for normal, healthy women. ff consis- tent, proven risk fxtors for cne of the ma)or conblbutors to panatal mar- bidity and mat&y could be identi-

ffed, then perhaps it would be Imps ta.nt to consider that those women at lisk should be gtven prophylactic therapies that would enabk them to remaininwcare.

treatment and prevention of pre- ecjampsia among 9364 pregnant women. Lancet 1994;343:619-29.

Reviewed by: Gail 5. Sutton. 5w.t. SUNY/Health Science Center at Brooklyn, Brooklyn. New York.

Synopsis

This 5.year study conducted by the CLASP CoUabomtive Group. based at Raddiif Iniinnay, Oxford. United Kingdom, randomized 9,364 women at 213 centers in matched groups that received aspirin or placebo in an attempt to study the eiieck of this drug on preedampsia and intrautef ine gmwtb retardation. Women were randomly assigned 60 mg of aspirin or matching placebo daily for pr* phylaxis of preeclampsia (74%). pm- phykxis of intrauterine grcwih retar- d&ion (12%). keatment of Pre- eclampsia (12%). or treatment 01 intrauterine growth retardation (3%). AUsubjeckwerebetweenlZand32 weeks’ g&&ion. Excluded from the study were women with an increased risk for bleeding, asthma, or allergr to aspirin, or the likelihood of irmne- diate deliven). Clitedcm for inclusion

included risk for or die&mosis of pre- e&mps*l 01 intrauterine growth re-

tar&ion, and clinidan uncertainty as to whether to recommend aspirin for the individual pregnancy. Details of compliance, use of concomitant drugs, and infant vital staUstlrs were also recorded.

The use of a 60-mg dose of aspirin was associated with a reduction of

only 12% in the incidence of pro- teinuric preeclampsia. compared with Placebo. The difference was not significant There was also no signif- icant effect on Qe incidence of in&a= utedne gmwtb retardation. stillbirth.

or neotxttal death. Aspirin did. how ever. reduce the jikelihood of pre- term delivery. It was not asscciated with an inctease tn placental hemar- rhage or bleeding during @dual an- estbes@ however, there was a slight lncroase in the incidence of blood

transfusion after aspirin therapy. Low-dose q&in was generally safe

for the fetus and neonate. The aver- age weight of all infants born to women in the aspirin group was 32 gm greater. and the average du- ration for pregnancy was 1 day greater than for the placebo group.

Co-nialy

The hope raked by earlier studies that a low dose of &tin might pre- vent or minimize preeclampsia has been dashed by this large study The authors conduded that the routine use of low-dose aspirh 15 not justified in all meanant women. Clinicians should. &=,ct ik use to women at particularly high lisk for early-onset pree&mpsia, which occurs roughly between 20 and 32 weeks’ gestation. UniorhJnately. accurate ways to pre- dict this are difficuk. “Since eadv- ansot preeclam~ can begin at any wne after 20 weeks’ gestation, it seems appropriate for such women to start prophylaxis before this time, especiauy since fata enby for them- peut+z reasons in CLASP was. if any- thing, &ted with increased peri- natal mortality.” the investigators said. Tbe findings were not unilomrly discouragng: Asphin signiikantly w duced the likelihood of weterm de-

ful studies make bigger headlines than those with h positive results, as rarqjvers we must be ca”ttaus for our clknk, their cbtldren, and our- sehres we can continue, tlowever, to give our clienk individualiid and sensitiw education dufing their preg- nanties, wi”‘h is the hallmark and priae of our &esion. Although as- @in was not the panacea we had hoped for, gad nubition, healthful lifestyle t&i, and mechanisms for stress reduction are a few examples

of inteiwntions we can effectively W.