Prevention of preeclampsia

ASPRE trial

The ASPRE trial (Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention) was an international multicenter study. Routine screening for preterm PE was carried out at 11-13 weeks’ gestation by the FMF algorithm that combines maternal factors and biomarkers in about 27,000 singleton pregnancies.

Eligible women (n=1,620) with estimated risk for preterm PE of >1 in 100 who agreed to participate in the trial were randomly allocated to aspirin (150 mg/day) or placebo from 11-14 weeks’ gestation until 36 weeks. The participants were recommended to take the tablet at night, rather than during the day, because there is some evidence that treatment at this time may be superior in reducing the rate of PE.

Use of aspirin was associated with a 62% reduction in the incidence of preterm PE and 82% reduction in the incidence of PE at <34 weeks’ gestation.

Rolnik DL, Wright D, Poon LC, O'Gorman N, Syngelaki A, de Paco Matallana C, Akolekar R, Cicero S, Janga D, Singh M, Molina FS, Persico N, Jani JC, Plasencia W, Papaioannou G, Tenenbaum-Gavish K, Meiri H, Gizurarson S, Maclagan K, Nicolaides KH. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med 2017 Jun 28. doi: 10.1056/NEJMoa1704559.

Secondary analysis of the data of the ASPRE trial showed that:

The beneficial effect of aspirin depends on compliance and the reduction in incidence of preterm PE may be about 75% in those with compliance of ≥90% and only 40% in those with compliance of <90%.
In chronic hypertension aspirin may not be useful in the prevention of preterm PE.
Consequently, if participants with chronic hypertension were excluded from the trial and compliance was ≥90%, aspirin could have potentially reduced the incidence of preterm PE by 95%.