RT Journal Article
T1 Aspirin for Evidence-Based Preeclampsia Prevention trial: effect of aspirin in prevention of preterm preeclampsia in subgroups of women according to their characteristics and medical and obstetrical history
A1 Poon, Liona C.
A1 Wright, David
A1 Rolnik, Daniel L.
A1 Syngelaki, Argyro
A1 Delgado, Juan Luis
A1 Tsokaki, Theodora
A1 Leipold, Gergo
A1 Akolekar, Ranjit
A1 Shearing, Siobhan
A1 De Stefani, Luciana
A1 Jani, Jacques C.
A1 Plasencia, Walter
A1 Evangelinakis, Nikolaos
A1 Gonzalez-Vanegas, Otilia
A1 Persico, Nicola
A1 Nicolaides, Kypros H.
K1 aspirin
K1 ASPRE trial
K1 chronic hypertension
K1 first-trimester screening
K1 mean arterial blood pressure
K1 placental growth factor
K1 pre-eclampsia
K1 pregnancy-associated plasma protein-A
K1 uterine artery Doppler
K1 Normal-pregnancy
K1 Weeks gestation
K1 Metaanalysis
K1 Hypertension
AB BACKGROUND: The Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention trial demonstrated that in women who were at high risk for preterm preeclampsia with delivery at = 30 years), body mass index (= 25 kg/m(2)), racial origin (Afro-Caribbean, Caucasian and other), method of conception (natural and assisted), cigarette smoking (smoker and non-smoker), family history of preterm preeclampsia (present and absent), obstetrical history (nulliparous, multiparous with previous preterm preeclampsia and multiparous without previous preterm preeclampsia), history of chronic hypertension (present and absent). Interaction tests were performed on the full data set of patients in the intention to treat population and on the data set of patients who took >= 90% of the prescribed medication. Results are presented as forest plot with P values for the interaction effects, group sizes, event counts and estimated odds ratios. We examined whether the test of interaction was significant at the 5% level with a Bonferroni adjustment for multiple comparisons.RESULTS: There was no evidence of heterogeneity in the aspirin effect in subgroups defined according to maternal characteristics and obstetrical history. In participants with chronic hypertension preterm preeclampsia occurred in 10.2% (5/49) in the aspirin group and 8.2% (5/61) in the placebo group (adjusted odds ratio, 1.29; 95% confidence interval, 0.33-5.12). The respective values in those without chronic hypertension were 1.1% (8/749) in the aspirin group and 3.9% (30/761) in the placebo group (adjusted odds ratio, 0.27; 95% confidence interval, 0.12-0.60). In all participants with adherence of >= 90% the adjusted odds ratio in the aspirin group was 0.24 (95% confidence interval, 0.09-0.65); in the subgroup with chronic hypertension it was 2.06 (95% confidence interval, 0.40-10.71); and in those without chronic hypertension it was 0.05 (95% confidence interval, 0.01-0.41). For the complete data set the test of interaction was not significant at the 5% level (P = .055), but in those with adherence ?90%, after adjustment for multiple comparisons, the interaction was significant at the 5% level (P = .0019).CONCLUSION: The beneficial effect of aspirin in the prevention of preterm preeclampsia may not apply in pregnancies with chronic hypertension. There was no evidence of heterogeneity in the aspirin effect in subgroups defined according to maternal characteristics and obstetrical history.
PB Mosby-elsevier
SN 0002-9378
YR 2017
FD 2017-11-01
LK http://hdl.handle.net/10668/18673
UL http://hdl.handle.net/10668/18673
LA en
DS RISalud
RD Apr 19, 2025