Aspirin Again Bested Placebo for Preventing Preterm Preeclampsia in High-Risk Women

Summary and Comment |
June 29, 2017

Aspirin Again Bested Placebo for Preventing Preterm Preeclampsia in High-Risk Women

  1. Robert L. Barbieri, MD

What prophylactic dose should be recommended?

  1. Robert L. Barbieri, MD

Severe preeclampsia is a notable cause of maternal and perinatal morbidity and mortality, and many studies have indicated that aspirin, compared with placebo, can reduce risk for developing the condition. In an international European study of the effects of low-dose aspirin on risk for preterm (<37 weeks' gestation) preeclampsia, investigators identified 1620 women at high risk for the disease based on a screening algorithm that included medical history, baseline mean arterial blood pressure, uterine-artery pulsatility index, and serum concentrations of pregnancy-associated plasma protein A and placental growth factor. Participants were randomized at 11 to 14 weeks' gestation to receive aspirin (150 mg daily) or placebo until 36 weeks.

Rates of preterm preeclampsia were 1.6% in the aspirin group versus 4.3% in the placebo group (odds ratio, 0.38; 95% confidence interval, 0.20–0.74; P=0.004). Incidence of adverse events (placental abruption, spontaneous preterm delivery, stillbirth, or low birth weight) did not differ between groups.

Comment

This study bolsters the evidence that aspirin has a favorable benefit-risk ratio for women at increased risk for preterm preeclampsia, here determined with first-trimester screening that combined medical history with measurement of vascular function and selected biomarkers. In the U.S., low-dose aspirin is widely available as an 81-mg tablet; in Europe, low-dose aspirin for preventing preeclampsia is generally prescribed as a 150-mg tablet. As some evidence indicates that the magnitude of aspirin's beneficial effect is dose-dependent, U.S. clinicians recommending this agent to prevent preeclampsia should consider advocating two daily 81-mg tablets.

Editor Disclosures at Time of Publication

  • Disclosures for Robert L. Barbieri, MD at time of publication Editorial boards UpToDate; OBG Management

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