Prophylactic use of aspirin can considerably bring down the incidence of preterm SGA

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

Abstract

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Daily low dose aspirin brings down rates of preterm preeclampsia in high risk women.

Courtesy: Preeclampsia Foundation

Women who received 150 mg of aspirin daily had 62% reduced risk of developing preterm preeclampsia (resulting in delivery before 37 weeks) and an 82% reduction in the rate of early preeclampsia (resulting in delivery before 34 weeks) as compared to women who received placebo reports the result of small randomized trial.  

The results of this Fetal Medicine Foundation’s (FMF’s) Project “ASPRE” was presented at the 16th World Congress in Fetal Medicine, 25-29th June 2017, Ljubljana, Slovenia as well as published online simultaneously in the New England Journal of Medicine.

Combined Multi-Marker Screening and Randomised Patient Treatment with Aspirin for Evidence-Based Pre-Eclampsia Prevention (ASPRE) is a multicentre collaboration on the prediction and prevention of preeclampsia sponsored by the Seventh Framework Programme of the European Union.

The FMF combined PerkinElmer’s highly sensitive DELFIA® Xpress PlGF 1-2-3™ assay, which is optimized for first trimester prediction of preeclampsia with mean arterial pressure, uterine-artery pulsatility index, to identify 1776 women with singleton pregnancies who were at high risk of developing preeclampsia.

The women were randomized at 11 to 14 weeks of gestation to receive either aspirin 150 mg per day, or placebo until 36 weeks of gestation and followed for delivery with preeclampsia before 37 weeks of gestation.

After randomization, 152 women did not want to participate and 4 were lost to follow-up, so the aspirin group has 798 women and the placebo group has 822 women.  

In an intent to treat analysis it was seen that preterm preeclampsia occurred in 13 women (1.6%) in aspirin group versus 35 women (4.3%) in the placebo group (P=0.004).

Other pregnancy complications like miscarriages, still births, pregnancy termination and neonatal deaths were comparable in both the groups, but the study was not designed to test secondary outcomes.

The authors concluded , “ This randomized trial showed that among women with singleton pregnancies who were identified by means of first-trimester screening as being at high risk for preterm preeclampsia, the administration of aspirin at a dose of 150 mg per day from 11 to 14 weeks of gestation until 36 weeks of gestation resulted in a significantly lower incidence of preterm preeclampsia than that with placebo.”

Full Text of the article in NEJM can be accessed here.