Aspirin Versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia

Rolnik, Daniel L.; Wright, Dave; Poon, Liona C.; O’Gorman, Neil; Syngelaki, A.; Matallana, Catalina De Paco; Akolekar, Ranjit; Cicero, S.; Janga, D.; Singh, Mandeep; Molina, F.; Persico, Nicola; Jani, Jacques; Plasencia, W.; Papaioannou, George; Tenenbaum-Gavish, K.; Meiri, Hamutal; Gizurarson, Sveinbjörn; Maclagan, Kate; Nicolaïdes, K. H.

doi:10.1097/01.aoa.0000529983.77883.af

Cited by 12 publications

(21 citation statements)

References 22 publications

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“…18 24 However, another controlled trial showed a reduction in preterm preeclampsia in patients that used aspirin. 25 Our patients, guided by the institution protocol, used aspirin prophylaxis throughout the pregnancy, as well as calcium supplementation, as this is recommended in some groups of patients such as those with SLE. 26…”

Section: Discussionmentioning

confidence: 99%

Perinatal Outcomes in Women with Chronic Kidney Diseases

Zilli

Borovac-Pinheiro

Costa

et al. 2022

Rev Bras Ginecol Obstet

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Objective To assess maternal and neonatal outcomes in women with chronic kidney disease (CKD) at a referral center for high-risk pregnancy. Methods A retrospective cohort of pregnant women with CKD was followed at the Women's Hospital of Universidade Estadual de Campinas, Brazil, between 2012 and 2020. Variables related to disease etiology, treatment duration, sociodemographic variables, lifestyle, other associated diseases, obstetric history, and perinatal outcomes were assessed. The causes of CKD were grouped into 10 subgroups. Subsequently, we divided the sample according to gestational age at childbirth, as preterm and term births, comparing maternal and neonatal outcomes, and baseline characteristics as well as outcomes among such groups. Results A total of 84 pregnancies were included, in 67 women with CKD. Among them, six pregnancies evolved to fetal death, five to miscarriage, and one was a twin pregnancy. We further analyzed 72 single pregnancies with live births; the mean gestational age at birth was 35 weeks and 3 days, with a mean birth weight of 2,444 g. Around half of the sample (51.39%) presented previous hypertension, and 27.7% developed preeclampsia. Among the preterm births, we observed a higher frequency of hypertensive syndromes, longer maternal intensive care unit (ICU) stay in the postpartum period, higher incidence of admission to the neonatal ICU, higher neonatal death, lower 5-minute Apgar score, and lower birth weight. Conclusion This study demonstrates increased adverse outcomes among pregnancies complicated by CKD and expands the knowledge on obstetric care among such women in an attempt to reduce maternal risks and identify factors related to prematurity in this population.

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Section: Discussionmentioning

confidence: 99%

Perinatal Outcomes in Women with Chronic Kidney Diseases

Zilli

Borovac-Pinheiro

Costa

et al. 2022

Rev Bras Ginecol Obstet

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“…10,11 The ASPRE trial did not find a significant difference in sPTB in the aspirin vs the placebo group. 12 Nevertheless, the results of an individual participant data meta-analysis including 17 RCT and 28,797 women showed a lower risk of sPTB at less than 37 weeks (RR 0.93, 95% CI 0.86-0.996) and less than 34 weeks (RR 0.86, 95% CI 0.76-0.99) in women assigned to antiplatelet treatment compared with placebo or no treatment. 14 On the basis of this finding, the authors suggested that prophylactic treatment with low-dose aspirin might be applied to a broader population of pregnant women other than those with a high risk of placental dysfunction.…”

Section: Women Who Delivered Spontaneously Preterm Had Lower Papp-a M...mentioning

confidence: 97%

“…8,9 Similarly, an imbalance in angiogenic factors with increased antiangiogenic elements such as soluble endoglin (sEng) and soluble fms-like tyrosine kinase receptor-1 (sFlt-1) has also been associated with sPTB and early-term birth. 10,11 The ASPRE study introduced a first-trimester screening algorithm for preterm PE that combines maternal cardiovascular and placental factors to recognise women at higher risk of early uteroplacental dysfunction 12 . A subsequent clinical-effectiveness study demonstrated that the prophylactic treatment with low-dose aspirin in women at high risk of preterm PE could reduce the incidence of preterm PE by 80%.…”

Section: Introductionmentioning

confidence: 99%

“…A subsequent clinical-effectiveness study demonstrated that the prophylactic treatment with low-dose aspirin in women at high risk of preterm PE could reduce the incidence of preterm PE by 80%. 12,13 In addition to a reduction in iPTB, low-dose aspirin prophylaxis might also reduce sPTB in pregnant women at risk of PE by 7% before 37 weeks and 14% before 34 weeks. 14 These findings are consistent with previous studies where all types of PTB were associated with low pregnancy-associated plasma protein (PAPP-A) and increased uterine artery Doppler pulsatility index (UtA-PI) in the first trimester.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Routine first‐trimester pre‐eclampsia screening and risk of preterm birth

Giorgione

Mendez

Pinas

et al. 2022

Ultrasound in Obstet & Gyne

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Objectives Preterm birth (PTB) is a major public health problem worldwide. It can occur spontaneously or be medically indicated for obstetric complications, such as pre‐eclampsia (PE) or fetal growth restriction. The main objective of this study was to investigate whether there is a shared uteroplacental etiology in the first trimester of pregnancy across PTB subtypes. Methods This was a retrospective cohort study of singleton pregnancies that underwent screening for preterm PE as part of their routine first‐trimester ultrasound assessment at a tertiary center in London, UK, between March 2018 and December 2020. Screening for preterm PE was performed using the Fetal Medicine Foundation algorithm, which includes maternal factors, mean arterial pressure (MAP), uterine artery pulsatility index (UtA‐PI) and pregnancy‐associated plasma protein‐A (PAPP‐A). Women with a risk of ≥ 1 in 50 for preterm PE were classified as high risk and offered prophylactic aspirin (150 mg once a day) and serial ultrasound assessments. The following delivery outcomes were evaluated: PTB < 37 weeks, iatrogenic PTB (iPTB) and spontaneous PTB (sPTB). Logistic regression analyses were performed to assess the association of PTB, iPTB and sPTB with an increased risk of preterm PE. A model for prediction of PTB < 37 weeks and < 33 weeks was developed and its performance was compared with that of an existing model in the literature. Results A total of 11 437 women were included in the study, of whom 475 (4.2%) had PTB. Of these, 308 (64.8%) were sPTB and 167 (35.2%) were iPTB. Patients with PTB had a higher body mass index, were more likely to be of black or Asian ethnicity, be smokers, have pregestational hypertension or diabetes, or have a history of previous PTB. They also had higher MAP (87.7 vs 86.0 mmHg, P < 0.0001), higher UtA‐PI multiples of the median (MoM) (0.99 vs 0.92, P < 0.0001) and lower PAPP‐A MoM (0.89 vs 1.08, P < 0.0001) compared to women with a term birth. In women at high risk of PE, the odds ratio for iPTB was 6.0 (95% CI, 4.29–8.43; P < 0.0001) and that for sPTB was 2.0 (95% CI, 1.46–2.86; P < 0.0001). A prediction model for PTB < 37 weeks and < 33 weeks, developed based on this cohort, included previous PTB, black ethnicity, chronic hypertension, diabetes mellitus, PAPP‐A MoM and UtA‐PI MoM. The performance of the model was similar to that of an existing first‐trimester prediction model for PTB < 33 weeks (area under the curve, 0.704 (95% CI, 0.653–0.754) vs 0.694 (95% CI, 0.643–0.746)). Conclusions Increased first‐trimester risk for uteroplacental dysfunction was associated with both iPTB and sPTB, implying a shared etiological pathway. The same factors used to predict PE risk show acceptable discrimination to predict PTB at < 33 weeks. Women at high risk of uteroplacental dysfunction may warrant additional monitoring and management for an increased risk of sPTB. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstet...

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“…The combination of a screening test with aspirin prophylaxis started before 16 GW can reduce the risk of PE before 37 GW by 62 % 17 .…”

Section: Integrating Doppler Ultrasound Into Obstetrics Managementmentioning

confidence: 99%