Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia

Summary of articles

• This is a multicenter, double-blind, placebo-controlled trial
• Purpose of this study: To determine whether intake of low-dose aspirin during pregnancy reduces the risk of preterm preeclampsia
• Method: 1620 pregnant patients who are at high risk for preterm preeclampsia
• Aspirin group: 798 patients. 150mg dose per day from 11 to 14 weeks of gestation until 36 weeks
• Placebo group: 822 patients receive placebo per day from 11 to 14 weeks of gestation until 36 weeks
• Outcomes

Both groups are followed until delivery

Primary outcomes: delivery with preeclampsia before 37 weeks of gestation

Secondary outcomes: adverse outcomes of pregnancy before 34 weeks of gestation, before 37 weeks of gestation and at or after 37 weeks of gestation, stillbirth or neonatal death, death and neonatal complications, neonatal therapy, and poor fetal growth (birth weight below 3^rd, 5^th, or 10^th percentile)

• Results:

Preterm preeclampsia occurred in 13 of 798 participants (1.6%) in the aspirin group, as compared with 35 of 822 (4.3%) in the placebo group

There were no significant between-group differences in the incidence of neonatal adverse outcomes or other adverse events

In the aspirin group, there were 11 miscarriages before 24 weeks of gestation,

2 pregnancy terminations for fetal abnormalities at or before 24 weeks of gestation, 1 pregnancy termination for severe fetal growth restriction and preeclampsia at 24 weeks of gestation, 7 stillbirths at or after 24 weeks of gestation, 1 neonatal death within 28 days after birth, and 776 live births of infants who survived until discharge from the hospital.

In the placebo group, there were 12 miscarriages before 24 weeks of gestation, 4 pregnancy terminations for fetal abnormalities at or before 24 weeks of gestation, no pregnancy terminations for severe fetal growth restriction and preeclampsia at 24 weeks of gestation, 12 stillbirths at or after 24 weeks of

gestation, 2 neonatal deaths within 28 days after birth, and 792 live births of infants who survived to discharge from the hospital.

• Conclusion

Treatment with low-dose aspirin in women at high risk for preterm preeclampsia resulted in a lower incidence of this diagnosis than placebo

• Relating to my patient

My patient, Ms. H is a 29 years old Hispanic female G1P0000, last menstrual period 8/18/18, estimated date of delivery 5/25/19, at estimated gestational age of 36 weeks and 4days with no reported past medical history presents to labor and delivery department complains of elevated blood pressure and headache for 2 days. Labs find out trace protein in the urine. She is diagnosed with preeclampsia. And the baby is not term yet. If the low-dose aspirin can reduce the incident of preeclampsia, it will be help in this case. Patient can start low dose aspirin and protect her from preeclampsia, which is dangerous to both mother and baby.

Article:

Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia

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