Highlights
- •This RTC examined preeclampsia prevention using low-dose aspirin.
- •Preventive and dose-dependent effects of aspirin on preeclampsia were confirmed.
- •Aspirin’s mechanism of action and effect on pregnancy outcomes are explained.
- •We identified the most suitable population for preeclampsia prevention with aspirin.
Abstract
Objectives
To evaluate the preventive effects of low-dose aspirin on the incidence of preeclampsia
and pregnancy outcomes of women at high-risk for preeclampsia.
Study design
This prospective randomized clinical trial was conducted at the Obstetrics Department
of The International Peace Maternity and Child Health Hospital, School of Medicine,
Shanghai Jiao Tong University, China. It analyzed data from 1105 high-risk women who
were divided into the control group (placebo group) and the aspirin group (including
three subgroups: 25 mg, 50 mg and 75 mg). The aspirin group in this study was instructed
to take aspirin daily before bedtime beginning in the 12th week of pregnancy. Main outcome measures: The primary outcome is the occurrence of preeclampsia. The secondary outcomes included
maternal and neonatal outcomes (such as premature delivery, FGR etc.), maternal serum
biomarkers (including d-dimers, platelet aggregation rates, etc.) and uterine arterial blood flow resistance.
The onset of preeclampsia and pregnancy outcomes were recorded after all participants
delivered.
Results
Low-dose aspirin significantly reduced the incidence of preeclampsia and early-onset
preeclampsia. Aspirin also showed significant dose dependence in preeclampsia prevention.
The results of Mantel-Haenszel trend test showed that there was a linear relationship
between the dosage and the incidence of preeclampsia and early preeclampsia (P < 0.05).
Pearson's results showed that the incidence of preeclampsia and early preeclampsia
was negatively correlated with aspirin dosage. There was also a linear relationship
between the dosage and the rates of postpartum hemorrhage, fetal growth restriction,
premature births and cesarean section (P < 0.05). There was no evidence to suggest
differences in the incidence of fetal distress, miscarriage and placental abruption
among the four groups. The blood resistance S/D value of uterine artery in early pregnancy
was the only independent factor affecting the efficacy of aspirin (OR = 1.405; 95
%CI,1.058–1.867; P = 0.019).
Conclusion
Low-dose aspirin can prevent preeclampsia and early-preeclampsia. Its efficacy is
dose-dependent. It can reduce the rates of postpartum hemorrhage, fetal growth restriction,
premature births and cesarean section. The prophylactic effect of aspirin on preeclampsia
seemed to be greater in patients with higher blood resistance S/D value of uterine
artery during early pregnancy.
Keywords
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Article info
Publication history
Published online: March 18, 2020
Accepted:
March 16,
2020
Received in revised form:
March 13,
2020
Received:
December 5,
2019
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
