1. 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
- Author
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Argyro Syngelaki, Siobhan Shearing, Jacques Jani, Nikolaos Evangelinakis, Daniel L. Rolnik, L. C. Poon, Nicola Persico, Gergo Leipold, Walter Plasencia, Theodora Tsokaki, Ranjit Akolekar, Otilia Gonzalez-Vanegas, Kypros H. Nicolaides, Juan Luis Delgado, Luciana De Stefani, David Wright, [Poon, Liona C.] Kings Coll Hosp London, London, England, [Rolnik, Daniel L.] Kings Coll Hosp London, London, England, [Syngelaki, Argyro] Kings Coll Hosp London, London, England, [Tsokaki, Theodora] Kings Coll Hosp London, London, England, [Leipold, Gergo] Kings Coll Hosp London, London, England, [Akolekar, Ranjit] Kings Coll Hosp London, London, England, [De Stefani, Luciana] Kings Coll Hosp London, London, England, [Nicolaides, Kypros H.] Kings Coll Hosp London, London, England, [Tsokaki, Theodora] North Middlesex Univ Hosp, London, England, [Leipold, Gergo] Lewisham Univ Hosp, London, England, [De Stefani, Luciana] Homerton Univ Hosp, London, England, [Poon, Liona C.] Chinese Univ Hong Kong, Hong Kong, Hong Kong, Peoples R China, [Wright, David] Univ Exeter, Exeter, Devon, England, [Delgado, Juan Luis] Hosp Clin Univ Virgen Arrixaca, Murcia, Spain, [Akolekar, Ranjit] Medway Maritime Hosp, Gillingham, England, [Shearing, Siobhan] Southend Univ Hosp, Southend On Sea, Essex, England, [Jani, Jacques C.] Univ Libre Bruxelles, Univ Hosp Brugmann, Brussels, Belgium, [Plasencia, Walter] Hospiten Grp, Tenerife, Canary Islands, Spain, [Evangelinakis, Nikolaos] Attikon Univ Hosp, Athens, Greece, [Gonzalez-Vanegas, Otilia] Hosp Univ San Cecilio, Granada, Spain, [Persico, Nicola] Osped Maggiore Policlin, Milan, Italy, Fetal Medicine Foundation, and European Union 7th Framework Program FP7-HEALTH-INNOVATION-2 (ASPRE)
- Subjects
placental growth factor ,Pregnancy-associated plasma protein A ,Weeks gestation ,030204 cardiovascular system & hematology ,Body Mass Index ,0302 clinical medicine ,Pre-Eclampsia ,Pregnancy ,Odds Ratio ,Family history ,Medical History Taking ,Reproductive History ,chronic hypertension ,education.field_of_study ,Aspirin ,030219 obstetrics & reproductive medicine ,Evidence-Based Medicine ,Obstetrics ,uterine artery Doppler ,Incidence ,Smoking ,Obstetrics and Gynecology ,Metaanalysis ,pregnancy-associated plasma protein-A ,Hypertension ,Premature Birth ,Female ,Algorithms ,medicine.drug ,Maternal Age ,mean arterial blood pressure ,Adult ,medicine.medical_specialty ,pre-eclampsia ,Reproductive Techniques, Assisted ,aspirin ,ASPRE trial ,first-trimester screening ,Population ,Pregnancy Complications, Cardiovascular ,Normal-pregnancy ,Subgroup analysis ,Gestational Age ,Risk Assessment ,Preeclampsia ,03 medical and health sciences ,medicine ,Humans ,education ,Gynecology ,business.industry ,Odds ratio ,Overweight ,medicine.disease ,Confidence interval ,Pregnancy Complications ,Pregnancy Trimester, First ,Logistic Models ,business ,Platelet Aggregation Inhibitors - Abstract
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 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 ( 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.
- Published
- 2017