Aspirin for Evidence-Based Preeclampsia Prevention trial: effect of aspirin in prevention of preterm preeclampsia in subgroups of women according to their characteristics and medical and obstetrical history

Abstract

The beneficial effect of aspirin in the prevention of preterm preeclampsia may not apply in pregnancies with chronic hypertension. There was no evidence of heterogeneity in the aspirin effect in subgroups defined according to maternal characteristics and obstetrical history.

Soluble B7‐H4 blood serum levels are elevated in women at high risk for preeclampsia in the first trimester, as well as in patients with confirmed preeclampsia

“…33 In our study, 25% of women at high risk of PE developed PE later in the pregnancy, despite taking aspirin. As seen in the ASPRE trial, patients with hypertension do not benefit from aspirin therapy 35 and, therefore, the percentage of PE manifestation of 25% in our cohort might be due to the risk profile of the cohort. 35 In part, the patients who presented to our clinic for screening were high-risk patients with maternal comorbidities, such as obesity, hypertension, and previous placental dysfunction.…”

“…We did not only include those patients who developed PE because all patients at high-risk received aspirin therapy and, therefore, the development of a PE was prevented by this therapy in a proportion of patients. 35 In part, the patients who presented to our clinic for screening were high-risk patients with maternal comorbidities, such as obesity, hypertension, and previous placental dysfunction. This is not surprising because approximately 30% of pregnant women are resistant to aspirin therapy, and the prevalence of non-responsiveness increase with the week of pregnancy, as shown by Caron et al 34 Our results are comparable to the results of the ASPRE-trial, in which PE was not prevented by aspirin in 18% of high-risk patients.…”

“…This finding emphasizes the severity of early-onset PE compared to late-onset PE. Only half of the cases of the late-onset form are neither preventable nor predictable early in pregnancy,6,35 which confirms that early-and lateonset PE might be based on different pathologies. However, it has been suggested that early-onset PE is caused by poor placentation during early pregnancy, whereas late-onset PE is considered a consequence of exposure to preexisting maternal risk factors 39,40.…”

Nouveaux regards sur la prééclampsie

“…L'une des suites de ce projet a été l'étude de la population, analysée et traitée, sous l'angle d'hétérogénéités de sousgroupes, apparemment sans effet en fonction des caractéristiques maternelles ou de leur histoire obstétricale. L'effet de l'aspirine disparaissait cependant dans un contexte d'hypertension chronique [39]. Une étude de transcriptomique avait détecté une augmentation de sFTL1 dans la PE et un taux accru est retrouvé dans le plasma des femmes présentant une PE précoce.…”

Why is the search for pre-eclampsia prevention so elusive?

“…Even aspirin has different effects on pre-eclampsia risk in different subgroups, according to recent studies 8. The proposal that pre-eclampsia phenotypes should be differentiated by the degree of placental involvement9 needs further exploration to help inform new options for both prevention and treatment.…”