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DOI: 10.1055/a-1226-6599
Die spontane Frühgeburt: Ist eine Prävention mit Aspirin möglich?
Article in several languages: English | deutsch
Zusammenfassung
Hintergrund Die Frühgeburtenrate in Deutschland ist mit 8,6% im Vergleich zu anderen europäischen Ländern sehr hoch. Da die Frühgeburt wesentlich zur perinatalen Morbidität und Mortalität beiträgt, müssen die bestehenden Präventionsstrategien weiter optimiert und ausgebaut werden. Circa ⅔ aller Frauen mit Frühgeburt haben vorzeitige Wehentätigkeit oder einen vorzeitigen Blasensprung. Sie werden unter dem Begriff der sogenannten spontanen Frühgeburt zusammengefasst im Gegensatz zur iatrogenen, beispielsweise infolge einer Präeklampsie oder einer fetalen Wachstumsretardierung. Neuere Untersuchungen lassen vermuten, dass mit niedrigdosiertem Aspirin nicht nur die Rate an iatrogenen, sondern auch an spontanen Frühgeburten weiter reduziert werden kann. Der gegenwärtige Kenntnisstand wird in der vorliegenden Übersichtsarbeit dargestellt.
Methode Es erfolgte eine selektive Literatursuche bis April 2020 in PubMed nach den Stichworten „randomized trial“, „randomized study“, „spontaneous preterm birth“, „aspirin“.
Ergebnisse Sekundäre Analysen von prospektiv-randomisierten Studien zur Prophylaxe der Präeklampsie mit niedrigdosiertem Aspirin zeigen, dass durch diese Intervention auch die Rate an spontanen Frühgeburten sowohl im Hoch- als auch im Niedrigrisikokollektiv signifikant gesenkt wird. In diese Richtung weist auch der ASPIRIN Trial, eine prospektive, randomisierte, doppelblinde Multicenterstudie in 6 Entwicklungsländern, in der nachgewiesen werden konnte, dass durch die tgl. Gabe von 81 mg Aspirin beginnend vor 14 Schwangerschaftswochen die Frühgeburtenrate bei Erstgebärenden ohne Vorerkrankungen um etwa 11% gesenkt wird (11,6 vs. 13,1%; RR 0,89; 95%-KI 0,81 – 0,98, p = 0,012).
Schlussfolgerung Weitere Studien zu dieser Thematik sind dringend notwendig. Sollten diese die vorliegenden Ergebnisse bestätigen, wäre eine generelle Aspirinprophylaxe für alle Schwangeren spätestens ab 12 SSW zu diskutieren.
Publication History
Received: 05 June 2020
Accepted after revision: 21 July 2020
Article published online:
28 January 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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