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
Publication in refereed journal

香港中文大學研究人員
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其它資訊
摘要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 <37 weeks’ gestation identified by screening by means of an algorithm that combines maternal factors and biomarkers at 11-13 weeks’ gestation, aspirin administration from 11 to 14 until 36 weeks’ gestation was associated with a significant reduction in the incidence of preterm preeclampsia (odds ratio 0.38; 95% confidence interval, 0.20 to 0.74; P=0.004).
Objective
We sought to examine whether there are differences in the effect of aspirin on the incidence of preterm preeclampsia in the Aspirin for Evidence-Based Preeclampsia Prevention trial in subgroups defined according to maternal characteristics and medical and obstetrical history.
Study Design
This was a secondary analysis of data from the Aspirin for Evidence-Based Preeclampsia Prevention trial. Subgroup analysis was performed to assess evidence of differences in the effect of aspirin on incidence of preterm preeclampsia in subgroups defined by maternal age (<30 and ≥30 years), body mass index (<25 and ≥25 kg/m2), 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.
出版社接受日期31.07.2017
著者Poon Liona C., Wright David, Rolnik Daniel L., Syngelaki Argyro, Delgado Juan Luis, Tsokaki Theodora, Leipold Gergo, Akolekar Ranjit, Shearing Siobhan, Stefani Luciana De, Jani Jacques C., Plasencia Walter, Evangelinakis Nikolaos, Gonzalez-Vanegas Otilia, Persico Nicola, Nicolaides Kypros H.
期刊名稱American Journal of Obstetrics and Gynecology
出版年份2017
月份11
卷號217
期次5
出版地New York
頁次585.e1 - 585.e5
國際標準期刊號0002-9378
語言美式英語
關鍵詞aspirin, ASPRE trial, chronic hypertension, first-trimester screening, mean arterial blood pressure, placental growth factor, preeclampsia, pregnancy-associated plasma protein-A, uterine artery Doppler

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