In Pre-gestational DM, you mentioned that to prevent PIH in overt-diabetics, we use low dose aspirin. What is the mechanism here? Aspirin is mostly used as an anticoagulant in low dose, and anti inflammatory in high dose.
The use of low-dose aspirin in pre-gestational diabetes mellitus (DM) to prevent pregnancy-induced hypertension (PIH) is based on its ability to mitigate the risk of preeclampsia rather than its anticoagulant or anti-inflammatory properties.
Preeclampsia is a serious complication of pregnancy characterized by high blood pressure and proteinuria (protein in the urine) after 20 weeks of gestation. It can lead to various complications for both the mother and the fetus, including eclampsia (seizures), organ damage, fetal growth restriction, and preterm birth.
The exact mechanism by which low-dose aspirin reduces the risk of preeclampsia is not fully understood, but it is believed to involve several potential pathways:
- Antiplatelet effects: Low-dose aspirin inhibits the activity of platelets, which are involved in the formation of blood clots. By reducing platelet aggregation, aspirin may improve placental blood flow and reduce the risk of vascular complications associated with preeclampsia.
- Vasodilation: Aspirin has been shown to have vasodilatory effects by enhancing the production of prostacyclin, a vasodilator, while inhibiting the production of thromboxane, a vasoconstrictor. Improved vascular function may help prevent the development of hypertension in pregnancy.
- Anti-inflammatory effects: Although low-dose aspirin is primarily used for its antiplatelet effects, it also has mild anti-inflammatory properties. Inflammation is thought to play a role in the pathogenesis of preeclampsia, and aspirin’s anti-inflammatory effects may contribute to its protective effects.
- Improvement of endothelial function: Endothelial dysfunction, characterized by impaired function of the cells lining blood vessels, is associated with the development of preeclampsia. Aspirin may help improve endothelial function, thereby reducing the risk of preeclampsia.
Overall, the use of low-dose aspirin in pre-gestational diabetes aims to reduce the risk of preeclampsia and its associated complications, rather than primarily acting as an anticoagulant or anti-inflammatory agent. It’s important for pregnant individuals with pre-gestational diabetes to discuss the potential benefits and risks of aspirin therapy with their healthcare provider, as individual circumstances may vary.