Aspirin as a prophylactic against pre-eclampsia

"In my opinion, aspirin is one of the most fascinating drugs in the field of medicine. It has such a diverse range of effects and these different effects have been gradually discovered over the years. It's really remarkable," says Helga Helgadóttir, lecturer at the UI Faculty of Pharmaceutical Sciences, whose research has focused on how aspirin can prevent pre-eclampsia in pregnant women.

Over the years, aspirin has been used to treat various ailments and diseases and remains the most used drug in the world, according to Helga. "It can be used as everything from a traditional painkiller and anti-inflammatory to a prophylactic against cardiovascular disease. Recently, we have started using it in high-risk pregnancies as a prophylactic against pre-eclampsia. Aspirin lowers blood pressure in pregnant women and reduces the likelihood of impaired foetal growth, gestational hypertension and early pre-eclampsia," says Helga.

Ten million women suffer from pre-eclampsia every year

She points out that although aspirin is being prescribed in high-risk pregnancies, the mechanism by which it prevents pre-eclampsia has not previously been understood. "The aim of this project, which was part of my PhD project, was to investigate whether it would be possible to describe aspirin's mode of action and how it can protect women against pre-eclampsia," explains Helga, who completed her PhD from the University of Iceland in late 2020 under the supervision of Sveinbjörn Gizurarson, professor at the Faculty of Pharmaceutical Sciences.

Finding ways to prevent pre-eclampsia is certainly an important goal, because the disease affects around 10 million pregnant women across the world every year. It is one of the world's leading causes of maternal death, killing around 76,000 women each year. "Pre-eclampsia is also believed to cause around 2.6 million premature births per year and it is estimated that every year around 500,000 children die because of the disease. Women who develop pre-eclampsia, and their children, are also at increased risk for developing various complications in later life, such as cardiovascular disease, obesity and diabetes. It is important to understand aspirin's mode of action so that we can add 'prophylactic against pre-eclampsia' to the uses of the drug. This will help ensure that as many women as possible around the world are able to receive appropriate preventative treatment, if they are considered at high risk of developing pre-eclampsia," explains Helga.

Aspirin has a powerful vasodilating effect

For this project, which was conducted at the University of Calabria in Italy, the University of Iceland, and Landspítali University Hospital, Helga looked at the effects of aspirin on pregnant and non-pregnant rats and also the effects on pregnant women. "We isolated arteries in the uterus and mesentery of 12-14 week old rats and looked at how aspirin affected the arteries using arteriograph methodology. We looked at rats that were not pregnant, 14 days pregnant and 20 days pregnant. The animal research showed that the drug had a direct vasodilating effect, so we decided to expand the research to also look at women who were 11-13 weeks pregnant," says Helga. 

This research was conducted at Landspítali University Hospital in collaboration with the obstetricians working there. "The results showed that aspirin has a powerful vasodilating effect, but that the effect was endothelium dependent in uterine and mesenteric arteries. The findings of the animal research also showed that arteries became less sensitive to aspirin depending on how advanced the rat's pregnancy was, 14 days or 20 days. This is significant information that supports the findings of previous research suggesting that it is important to start taking aspirin in the early stages of pregnancy, at least before 16 weeks. If treatment starts after that point, the aspirin has a reduced effect," says Helga.

By demonstrating that aspirin has a direct vasodilating effect on arteries and by better describing how the drug works, Helga and her colleagues have laid the scientific foundation for prescribing aspirin to pregnant women at risk for pre-eclampsia.

Helga is an early career researcher whose interests are focused primarily on clinical research. She has been involved in and directed the development of pharmaceutical forms and clinical drug trials, including for the start-up company Capretto. "I am particularly interested in pregnancy-related conditions, especially those originating in the placenta, such as pre-eclampsia," says Helga, who plans to continue research in this field.