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#Grand Rounds

Does Aspirin for Preeclampsia Risk Reduction Affect Biomarkers or Fetal Growth?

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BACKGROUND AND PURPOSE:

  • Low-dose aspirin prior to 16 weeks can reduce preeclampsia risk in at-risk pregnancies
  • There is still limited understanding as to how aspirin may work in low-risk women in general
    • Research could help explain potential impact in preventing placental pathology
  • Mone et al. (Am J Perinatol., 2019) sought to determine the effect of aspirin use in low-risk pregnancy on
    • PAPP-A and placental-like growth factor (PLGF)
    • Urinary albumin-to-creatinine ratio (ACR) and blood pressure
    • Fetal growth
    • Placental histopathology and fetal-to-placental weight (FPW)

METHODS:

  • Secondary analysis of a randomized trial (RCT)
    • TEST study: Trial of low-dose aspirin with an Early Screening Test
    • RCT to assess aspirin and effect on preeclampsia and growth restriction
    • Feasibility study, not powered for efficacy
  • TEST study methods: 546 low-risk nulliparous women were randomized at 11 weeks to receive one of the following
    • Routine aspirin 75 mg once daily from 11 until 36 weeks (n = 179)
    • No aspirin (n = 183)
    • Aspirin administered based on FMF screening test (n=184)
      • FMF inputs: Maternal history | Blood pressure | Uterine artery Doppler | PAPP-A and PLGF levels
    • Blood pressure | PAPP-A | PLGF | ACR
      • Baseline
      • Repeated at 9 to 10 weeks following aspirin
    • Fetal Growth studies
    • Gross and histopathological placental analyses
    • Multiple linear regression model used to compare aspirin vs nonaspirin-taking women
      • Controlled for maternal weight, ethnicity, smoking status, and ovulation-induced conception

RESULTS:

  • In current study, 445 subjects were included
    • Aspirin 163 | 282 no aspirin
  • Compared to the placebo group, the aspirin group had greater
    • Fetal-to-placental weight ratio: 7.5 vs. 7.3 (p = 0.045)
    • Change in EFW between second and third trimesters: 1,624.5 g vs. 1,606.2g (p = 0.042)
  • However, there was no significant difference in birth weight or fetal growth restriction
  • Aspirin did not significantly impact on change in serum or urine preeclampsia biomarkers, maternal blood pressure, or placental histopathology

CONCLUSION:

  • Study limitations include
    • Aspirin dose (may be too low)
    • Non-blinded design
    • 8% of aspirin subjects came from higher risk group ‘3’ (FMF criteria)
  • Strengths include RCT design and methods
  • Aspirin use in low-risk pregnancy did not significantly impact preeclampsia biomarkers, fetal growth, or placental pathology

Learn More – Primary Sources:

Evaluation of the Effect of Low-Dose Aspirin on Biochemical and Biophysical Biomarkers for Placental Disease in Low-Risk Pregnancy: Secondary Analysis of a Multicenter RCT.

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Related ObG Topics:

Aspirin Treatment for Women at Risk for Preeclampsia – ACOG and USPSTF Recommendations  
ASPRE Trial: A Combined Risk Algorithm and Use of Aspirin to Prevent Preterm Preeclampsia

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