Use of
prophylactic aspirin in high-risk group identified by first trimester screening
for preeclampsia would considerably lower the incidence of preterm and early
SGA by about 20% and 40%, respectively report the results of a data analysis
published July 2018 in ISUOG (International Society of Ultrasound in Obstetrics
and Gynecology) journal Ultrasound in Obstetrics and Gynecology.
The
researchers analyzed the data from two multicentric trials: Screening program
for pre-eclampsia (SPREE) study and the Aspirin for Evidence-Based Preeclampsia
Prevention trial (ASPRE). SPREE is a prospective multicenter cohort study that
screened women for PE during 11-13 weeks by measuring Mean arterial pressure
(MAP), Uterine artery pulsatility index (UtA‐PI), Serum placental growth factor
(PlGF), and Serum pregnancy‐associated plasma protein‐A (PAPP‐A).
ASPRE trial
examined the prophylactic effect of low-dose aspirin started at 11-14 weeks for
prevention of PE in women at increased risk for preterm PE. The results demonstrated that aspirin reduces
the incidence of early-PE by 89% and pre-term PE by 62% but does not much
reduce the incidence of term PE.
The combined
use of maternal factors mean arterial pressure, uterine artery pulsatility
index and serum placental growth factor for the screening for preterm
preeclampsia identifies a high proportion of patients who will develop small
for gestational age (SGA) babies.
Screening in
SPREE trial identified 46% of SGA <10th Percentile neonate born before 37
weeks and 56% of those born before 32 weeks with a screen positive rate of
12.2%. Analysis of data from ASPRE trial showed that aspirin reduced the rate
of SGA <10th Percentile by 40% in babies born at or before 37 weeks and by
73% in babies born before 32 weeks.
The decrease
in the incidence of SGA infants was mainly due to a substantial decrease in the
incidence of PE to the amount of 90% in babies born before 32 weeks and 70% in
babies born at or before 37 weeks.
Hence, the
authors concluded that first-trimester screening of PE identifies a high proportion
of patients with who will develop preterm-SGA as the pregnancy progresses
further and the prophylactic use of aspirin can prevent that.
Here is a
Video abstract of the above study
