ASPRE trial: risk factors for development of preterm pre‐eclampsia despite aspirin prophylaxis

Abstract

In pregnancies at high-risk of preterm preeclampsia, very high-risk results (estimated risk ≥1 in 50), compared to estimated risk of 1 in 51 to 1 in 100, and low PlGF concentration <0.712 MoM, compared to PlGF ≥0.712 MoM, are associated with the development of preterm preeclampsia despite What are the clinical implications of this work?Our results have clarified who we need to follow up more closely during pregnancy despite aspirin prophylaxis. Women with identified risk factors should be informed of the potential risk of developing preeclampsia despite aspirin use and that they are offered more frequent monitoring of blood pressure.

Re: ASPRE trial: risk factors for development of preterm pre‐eclampsia despite aspirin prophylaxis

“…A secondary analysis performed in the original ASPRE trial indicated lack of efficacy of aspirin in reducing preterm pre-eclampsia in women with chronic hypertension 3 . The current additional secondary analysis of the same ASPRE data and two previous randomized controlled trials also came to the same conclusion 1,4,5 . However, the limitations of the secondary analysis of ASPRE data, as acknowledged by the authors, and the lower dosage and later gestation at commencement of aspirin used in earlier trials undermine the reliability of such a conclusion.…”

“…We read the paper by Shen et al 1 with great interest. The authors undertook a secondary analysis of the ASPRE (Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Pre-eclampsia Prevention) trial 2 and suggested in their report that women at high risk (> 1 in 50) of preterm pre-eclampsia, those affected by chronic hypertension and those with low levels of placental growth factor (PlGF) (< 0.712 multiples of the median (MoM)) were more likely to be resistant to low-dose, 150-mg aspirin prophylaxis and to develop preterm pre-eclampsia.…”

Reply

“…In our study 4 , table 2 demonstrates clearly that PlGF MoM, as a continuous variable, is predictive of preterm pre-eclampsia amongst high-risk women treated with aspirin. The subgroup analyses (tables 3 and 4) explored the key contributors to preterm pre-eclampsia development in the three risk categories.…”

“…Our intentions in this secondary analysis of the ASPRE data were two-fold 4 . First, to identify those who are at risk of subsequent development of preterm pre-eclampsia following aspirin treatment.…”

Incidence of pre‐eclampsia and other perinatal complications among pregnant women with congenital heart disease: systematic review and meta‐analysis

“…Maternal congenital heart disease (CHD) is associated with reduced cardiovascular adaptation during pregnancy 9,10 , and, according to the cardiovascular theory of the origin of PE, it would be expected that pregnant women with CHD would have a higher incidence of PE. So far, international guidelines do not include CHD as a risk factor for PE [11][12][13] , potentially preventing these women from receiving effective prophylactic intervention with low-dose aspirin, which may halve the incidence of preterm PE in women at high risk when started early in pregnancy 14,15 . This is particularly relevant given that advances in medical and surgical treatments in recent years have led to more than 90% of children with CHD surviving into adulthood, which has translated into a 2-fold increase in the number of pregnant women with CHD in the last two decades 16 .…”