PICOT Study:determine which between a low daily dose of aspirin (LDA) and Physical Exercise is most effective at reducing the PE risk during a high-risk pregnancy.

Introduction

Preeclampsia is a prenatal condition that often manifests during the 20th week of

pregnancy characterized by elevated blood pressure and proteinuria. Prevalence of this condition

among pregnant women is assessed to range between 2 and 8% globally (Raguema, Benletaifa,

Mahjoub, & Lavoie, 2020). It is regarded as the primary global root of maternal and fetal death

and morbidity (Raguema, Benletaifa, Mahjoub, & Lavoie, 2020). Although some data suggest

that the condition stems from vascular endothelial cell dysfunction relative to the declining

synthesis of vasodilators, a definite cause is yet to be established. Preeclampsia poses a

significant risk during pregnancy, but antihypertensive medications may also endanger the fetus

or the mother (Awad, Hasanin, Taha, & Gabr, 2019). This analysis aims to determine which

between a low daily dose of aspirin (LDA) and Physical Exercise is most effective at reducing

the PE risk during a high-risk pregnancy.

PICOT Question

In high-risk pregnant women (P), does daily low-dose Aspirin (I) offer greater risk reduction for

preterm Preeclampsia (O) compared to daily physical exercise (C) during the 9-month pregnancy

period (T)?

Literature Review

Effects of Low Daily Dose of Aspirin (LDA) on Preterm Preeclampsia (PE)

Studies on the effects of LDA on PE in pregnant women have been conducted for more

than 40 years, however, the results are still inconclusive due to contradicting outcomes

( Shanmugalingam, et al., 2020). One of the key issues behind the inconsistencies in these

studies is the utilization of different variables. For example, even among studies that find LDA to

be effective, the recommended Dosages might differ. Subsequently, in this analysis, we'll

, establish 50-150 Milligrams Dosage (mg/d) of Aspirin as the LDA parameter, and identify

possibilities of Aspirin resistance, Non-adherence, and any other factors that might compromise

data validity.

An investigation into the demographics of Asia and the impact of LDA on PE among

Asian pregnant women was conducted in China. The major emphasis of the study was 100 mg/d,

for which LDA was found to be ineffective in reducing PE risk from 12, 20 to 34 gestational

weeks. Further research into other dosages 60 mg, 75mg, and 81mg identified that the dosage

was also ineffective. However, the study identified that 150mg of Aspirin was effective in

mitigating the risk of PE (Lin, et al., 2021). Henderson, Vesco, Senger, Thomas, & Redmond

(2021) study, performed a similar study except for the location and demography. The findings

identified that different dosages were effective including, 10% efficacy at 60mg/d, greater

efficacy at 75mg/d, and 28% efficacy at 150mg/d. It's important to consider that the US

Preventive Service Task Force (USPSTF) recognizes 81 mg/d as a low dosage in the study.

Further, while Henderson, Vesco, Senger, Thomas, & Redmond's (2021) study identified

different rates of PE among different races, it's important to note that Lin, et al., (2021)

highlights that china's LDA is typically suboptimal. Consequently, the difference in effectivity is

likely a result of the potency of the Aspirin i.e., the potency difference between Aspirin supplied

in America and those from China.

To acquire valid data that supports the effectiveness of LDA in minimizing the risk of

PE, we must consider an issue raised in the aforementioned studies. Although the difference in

potency in the supply of Aspirin might explain the variance in effectiveness, the question of

whether ethnicity plays a factor cannot be ignored. According to the Henderson, Vesco, Senger,

Thomas, and Redmond (2021) study, racial differences in PE prevalence exist. In contrast to