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. 2024 Feb;131(3):334-342.
doi: 10.1111/1471-0528.17631. Epub 2023 Aug 9.

Mid-trimester uterine artery Doppler for aspirin discontinuation in pregnancies at high risk for preterm pre-eclampsia: Post-hoc analysis of StopPRE trial

Erika Bonacina  1 , Pablo Garcia-Manau  1 , Monica López  2 , Sara Caamiña  3 , Àngels Vives  4 , Eva Lopez-Quesada  5 , Marta Ricart  6 , Anna Maroto  7 , Laura de Mingo  8 , Elena Pintado  9 , Laura Castillo-Ribelles  10 , Lourdes Martín  2 , Alicia Rodriguez-Zurita  3 , Esperanza Garcia  4 , Mar Pallarols  5 , Laia Vidal-Sagnier  6 , Mireia Teixidor  7 , Carmen Orizales-Lago  8 , Adela Pérez-Gomez  3 , Vanesa Ocaña  9 , Linda Puerto  2 , Pilar Millán  4 , Mercè Alsius  11 , Sonia Diaz  9 , Nerea Maiz  1 , Elena Carreras  1 , Anna Suy  1 , Manel Mendoza  1
Affiliations

Mid-trimester uterine artery Doppler for aspirin discontinuation in pregnancies at high risk for preterm pre-eclampsia: Post-hoc analysis of StopPRE trial

Erika Bonacina et al. BJOG. 2024 Feb.

Abstract

Objective: To assess whether aspirin treatment can be discontinued in pregnancies with normal uterine artery pulsatility index (≤90th percentile) at 24-28 weeks.

Design: Post-hoc analysis of a clinical trial.

Setting: Nine maternity hospitals in Spain.

Population or sample: Pregnant individuals at high risk of pre-eclampsia at 11-13 weeks and normal uterine artery Doppler at 24-28 weeks.

Methods: All participants received treatment with daily aspirin at a dose of 150 mg. Participants were randomly assigned, in a 1:1 ratio, either to continue aspirin treatment until 36 weeks (control group) or to discontinue aspirin treatment (intervention group), between September 2019 and September 2021. In this secondary analysis, women with a UtAPI >90th percentile at 24-28 weeks were excluded. The non-inferiority margin was set at a difference of 1.9% for the incidence of preterm pre-eclampsia.

Main outcome measures: Incidence of preterm pre-eclampsia.

Results: Of the 1611 eligible women, 139 were excluded for UtAPI >90th percentile or if UtAPI was not available. Finally, 804 were included in this post-hoc analysis. Preterm pre-eclampsia occurred in three of 409 (0.7%) women in the aspirin discontinuation group and five of 395 (1.3%) women in the continuation group (-0.53; 95% CI -1.91 to 0.85), indicating non-inferiority of aspirin discontinuation.

Conclusions: Discontinuing aspirin treatment at 24-28 weeks in women with a UtAPI ≤90th percentile was non-inferior to continuing aspirin treatment until 36 weeks for preventing preterm pre-eclampsia.

Keywords: Doppler; aspirin; pre-eclampsia; salicylic acid; screening; uterine artery.

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References

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