<scp>ASPRE</scp> trial: effects of aspirin on mean arterial blood pressure and uterine artery pulsatility index trajectories in pregnancy

Rolnik, Daniel L.; Syngelaki, Argyro; O’Gorman, Neil; Wright, David C.; Poon, Liona C.; Nicolaides, K. H.

doi:10.1002/uog.26222

Cited by 11 publications

(5 citation statements)

References 31 publications

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“…The lack of a placebo treatment group, non-reporting of early-onset PE, non-reporting of the gestational age upon commencement of aspirin, use of an 80 mg dose of aspirin, and small sample size limits this study’s ability to make conclusions about the effect of aspirin on pregnancy complications. Nevertheless, its finding of a significant reduction in UtAPI at 20 weeks is consistent with results reported in other high-risk groups treated with aspirin [ 237 ]. The paucity of studies evaluating the use of aspirin in pregnant women with PCOS may reflect a lack of appreciation for the increased risk of complications and highlights the need for the inclusion of women with PCOS in risk assessment models.…”

Section: Identification Assessment and Management Of Women With Pcos ...supporting

confidence: 90%

Reducing the Risk of Pre-Eclampsia in Women with Polycystic Ovary Syndrome Using a Combination of Pregnancy Screening, Lifestyle, and Medical Management Strategies

Parker,

O’Brien,

Yeoh

et al. 2024

JCM

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Polycystic ovary syndrome (PCOS) is a multisystem disorder that presents with a variety of phenotypes involving metabolic, endocrine, reproductive, and psychological symptoms and signs. Women with PCOS are at increased risk of pregnancy complications including implantation failure, miscarriage, gestational diabetes, fetal growth restriction, preterm labor, and pre-eclampsia (PE). This may be attributed to the presence of specific susceptibility features associated with PCOS before and during pregnancy, such as chronic systemic inflammation, insulin resistance (IR), and hyperandrogenism, all of which have been associated with an increased risk of pregnancy complications. Many of the features of PCOS are reversible following lifestyle interventions such as diet and exercise, and pregnant women following a healthy lifestyle have been found to have a lower risk of complications, including PE. This narrative synthesis summarizes the evidence investigating the risk of PE and the role of nutritional factors in women with PCOS. The findings suggest that the beneficial aspects of lifestyle management of PCOS, as recommended in the evidence-based international guidelines, extend to improved pregnancy outcomes. Identifying high-risk women with PCOS will allow targeted interventions, early-pregnancy screening, and increased surveillance for PE. Women with PCOS should be included in risk assessment algorithms for PE.

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Section: Identification Assessment and Management Of Women With Pcos ...supporting

confidence: 90%

Reducing the Risk of Pre-Eclampsia in Women with Polycystic Ovary Syndrome Using a Combination of Pregnancy Screening, Lifestyle, and Medical Management Strategies

Parker,

O’Brien,

Yeoh

et al. 2024

JCM

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“…30 In addition, a detailed analysis of ASPRE data on the course of MAP and UtA-PI in PE high-risk pregnant women who started taking aspirin at less than 16 weeks' gestation showed that aspirin did not affect MAP but improved UtA-PI at less than 20 weeks. 31…”

Section: Pe Prevention With Aspirin After First-trimester Pe Predicti...mentioning

confidence: 99%

First‐trimester preterm preeclampsia prediction model for prevention with low‐dose aspirin

Pooh

2024

J of Obstet and Gynaecol

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IntroductionPreeclampsia (PE) is a major maternal and fetal threat. Previous risk‐scoring methods in guidelines lacked precision. The Fetal Medicine Foundation (FMF) proposed a first‐trimester PE screening model using Bayes' theorem.PE Prediction ModelFMF prediction model combines maternal characteristics and medical/obstetrical history to determine prior risk and further incorporate maternal blood pressure, maternal serum biomarkers, and uterine Doppler pulsatility index expressed as multiples of the median (MoM) to estimate posterior risk.Low‐Dose Aspirin PreventionLow‐dose aspirin is one of the potential PE prevention strategies. Initiating it before 16 weeks is crucial. Aspirin's antiplatelet and anti‐inflammatory properties align with PE's pathophysiology. Dosing and resistance warrant further study, but a standard regimen of 150 mg nightly, starting before 16 weeks, is widely supported.PE Prevention in PracticeClinical trials, including ASPRE, affirm aspirin's role in PE prevention. Starting aspirin based on FMF screening significantly reduces preterm PE and associated complications.Advancements and ProspectsEmerging research explores predictors like maternal ophthalmic arterial waveform. Regional variations, especially in Asian populations, are considered. Machine learning and AI show promise, but examiner expertise remains essential for accurate prediction.In conclusion, integrating FMF's first‐trimester PE screening with low‐dose aspirin offers a promising strategy. Further advancements may enhance precision and broaden prevention efforts.

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“…First, it must be understood that aspirin is most effective in preventing early forms of PE, typically associated with deep placentation disorders, and rarely those at term. Recent studies have shown that aspirin significantly improves pulsatility indices assessed by uterine artery Doppler, a surrogate marker of impaired placentation [10,15,45]. Consequently, we need to be able to identify women at risk of preterm pre-eclampsia, i.e., those with profound placental dysfunction or at high risk of developing it.…”

Section: Future Directionsmentioning

confidence: 99%

Aspirin at 75 to 81 mg Daily for the Prevention of Preterm Pre-Eclampsia: Systematic Review and Meta-Analysis

Demuth,

Pellan,

Boutin

et al. 2024

JCM

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Background: Aspirin at 150 mg daily, initiated in the 1st trimester of pregnancy, prevents preterm pre-eclampsia. We aimed to estimate whether a dose of 75 to 81 mg daily can help to prevent preterm pre-eclampsia as well. Methods: A systematic search was conducted using multiple databases and meta-analyses of randomized controlled trials (RCTs) that compared aspirin initiated in the first trimester of pregnancy to placebo or no treatment, following the PRISMA guidelines and the Cochrane risk of bias tool. Results: We retrieved 11 RCTs involving 13,981 participants. Five RCTs had a low risk of bias, one at unclear risk, and fiver had a high risk of bias. A pooled analysis demonstrated that doses of 75 to 81 mg of aspirin, compared to a placebo or no treatment, was not associated with a significant reduction in preterm pre-eclampsia (8 studies; 12,391 participants; relative risk, 0.66; 95% confidence interval: 0.27 to 1.62; p = 0.36), but there was a significant heterogeneity across the studies (I2 = 61%, p = 0.02). Conclusion: It cannot be concluded that taking 75 to 81 mg of aspirin daily reduces the risk of preterm pre-eclampsia. However, given the significant heterogeneity between the studies, the true effect that such a dose of aspirin would have on pregnancy outcomes could not be properly estimated.

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ASPRE trial: effects of aspirin on mean arterial blood pressure and uterine artery pulsatility index trajectories in pregnancy

Cited by 11 publications

References 31 publications

Reducing the Risk of Pre-Eclampsia in Women with Polycystic Ovary Syndrome Using a Combination of Pregnancy Screening, Lifestyle, and Medical Management Strategies

Reducing the Risk of Pre-Eclampsia in Women with Polycystic Ovary Syndrome Using a Combination of Pregnancy Screening, Lifestyle, and Medical Management Strategies

First‐trimester preterm preeclampsia prediction model for prevention with low‐dose aspirin

Aspirin at 75 to 81 mg Daily for the Prevention of Preterm Pre-Eclampsia: Systematic Review and Meta-Analysis

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