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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
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
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| Published in: | American journal of obstetrics and gynecology 2017-11, Vol.217 (5), p.585.e1-585.e5 |
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| creator | Poon, Liona C. Wright, David Rolnik, Daniel L. Syngelaki, Argyro Delgado, Juan Luis Tsokaki, Theodora Leipold, Gergo Akolekar, Ranjit Shearing, Siobhan De Stefani, Luciana Jani, Jacques C. Plasencia, Walter Evangelinakis, Nikolaos Gonzalez-Vanegas, Otilia Persico, Nicola Nicolaides, Kypros H. |
| description | 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 |
| doi_str_mv | 10.1016/j.ajog.2017.07.038 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1927304627</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0002937817309298</els_id><sourcerecordid>1927304627</sourcerecordid><originalsourceid>FETCH-LOGICAL-c400t-6d3ab4eec1b6a0ce890428772ca1d036b41549f618c529a05cb104a697668f5e3</originalsourceid><addsrcrecordid>eNp9UcFu1DAQtRCILgs_wAH5yCWLnXgdB3EpVQtIleihnK2JPdn1KomD7SzqT_JNddiF3pCePH7ym6cZP0LecrbhjMsPhw0c_G5TMl5vWEalnpEVZ01dSCXVc7JijJVFU9XqgryK8bDQsilfkotS1UoIXq_I78s4ueBG2vlAr4_O4miw-AwRLb0LiKaHYYoOFnLEMTk_0hQc9B8pdh2aRH1H4eyRMT3J8kNmCcOw1CenrIpzuwt-nuIi-uUHHCkY44N1444mT9MeXaBmDwFMNnAxORMpjJYOaJ2B_s_dtzFhHmbh-6zx4eE1edFBH_HNua7Jj5vr-6uvxe33L9-uLm8LIxhLhbQVtCLPxFsJzKBqmMh_UpcGuGWVbAXfiqaTXJlt2QDbmpYzAbKppVTdFqs1eX_ynYL_OWNMenDRYN_DiH6OmjdlXTEh87km5Ulqgo8xYKen4AYID5ozveSoD3rJUS85apZRqdz07uw_t3nlfy1_g8uCTycB5i2PDoOOxi3ZWRdyKtp69z__R-BXtGA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1927304627</pqid></control><display><type>article</type><title>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</title><source>ScienceDirect Freedom Collection 2022-2024</source><creator>Poon, Liona C. ; Wright, David ; Rolnik, Daniel L. ; Syngelaki, Argyro ; Delgado, Juan Luis ; Tsokaki, Theodora ; Leipold, Gergo ; Akolekar, Ranjit ; Shearing, Siobhan ; De Stefani, Luciana ; Jani, Jacques C. ; Plasencia, Walter ; Evangelinakis, Nikolaos ; Gonzalez-Vanegas, Otilia ; Persico, Nicola ; Nicolaides, Kypros H.</creator><creatorcontrib>Poon, Liona C. ; Wright, David ; Rolnik, Daniel L. ; Syngelaki, Argyro ; Delgado, Juan Luis ; Tsokaki, Theodora ; Leipold, Gergo ; Akolekar, Ranjit ; Shearing, Siobhan ; De Stefani, Luciana ; Jani, Jacques C. ; Plasencia, Walter ; Evangelinakis, Nikolaos ; Gonzalez-Vanegas, Otilia ; Persico, Nicola ; Nicolaides, Kypros H.</creatorcontrib><description>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).
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.
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.
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).
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.</description><identifier>ISSN: 0002-9378</identifier><identifier>EISSN: 1097-6868</identifier><identifier>DOI: 10.1016/j.ajog.2017.07.038</identifier><identifier>PMID: 28784417</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Algorithms ; aspirin ; Aspirin - therapeutic use ; ASPRE trial ; Body Mass Index ; chronic hypertension ; Evidence-Based Medicine ; Female ; first-trimester screening ; Gestational Age ; Humans ; Hypertension - epidemiology ; Incidence ; Logistic Models ; Maternal Age ; mean arterial blood pressure ; Medical History Taking ; Odds Ratio ; Overweight - epidemiology ; placental growth factor ; Platelet Aggregation Inhibitors - therapeutic use ; Pre-Eclampsia - prevention & control ; preeclampsia ; Pregnancy ; Pregnancy Complications - epidemiology ; Pregnancy Complications, Cardiovascular - epidemiology ; Pregnancy Trimester, First ; pregnancy-associated plasma protein-A ; Premature Birth ; Reproductive History ; Reproductive Techniques, Assisted - utilization ; Risk Assessment ; Smoking - epidemiology ; uterine artery Doppler</subject><ispartof>American journal of obstetrics and gynecology, 2017-11, Vol.217 (5), p.585.e1-585.e5</ispartof><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-6d3ab4eec1b6a0ce890428772ca1d036b41549f618c529a05cb104a697668f5e3</citedby><cites>FETCH-LOGICAL-c400t-6d3ab4eec1b6a0ce890428772ca1d036b41549f618c529a05cb104a697668f5e3</cites><orcidid>0000-0001-5856-6072</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28784417$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Poon, Liona C.</creatorcontrib><creatorcontrib>Wright, David</creatorcontrib><creatorcontrib>Rolnik, Daniel L.</creatorcontrib><creatorcontrib>Syngelaki, Argyro</creatorcontrib><creatorcontrib>Delgado, Juan Luis</creatorcontrib><creatorcontrib>Tsokaki, Theodora</creatorcontrib><creatorcontrib>Leipold, Gergo</creatorcontrib><creatorcontrib>Akolekar, Ranjit</creatorcontrib><creatorcontrib>Shearing, Siobhan</creatorcontrib><creatorcontrib>De Stefani, Luciana</creatorcontrib><creatorcontrib>Jani, Jacques C.</creatorcontrib><creatorcontrib>Plasencia, Walter</creatorcontrib><creatorcontrib>Evangelinakis, Nikolaos</creatorcontrib><creatorcontrib>Gonzalez-Vanegas, Otilia</creatorcontrib><creatorcontrib>Persico, Nicola</creatorcontrib><creatorcontrib>Nicolaides, Kypros H.</creatorcontrib><title>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</title><title>American journal of obstetrics and gynecology</title><addtitle>Am J Obstet Gynecol</addtitle><description>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).
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.
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.
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).
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.</description><subject>Adult</subject><subject>Algorithms</subject><subject>aspirin</subject><subject>Aspirin - therapeutic use</subject><subject>ASPRE trial</subject><subject>Body Mass Index</subject><subject>chronic hypertension</subject><subject>Evidence-Based Medicine</subject><subject>Female</subject><subject>first-trimester screening</subject><subject>Gestational Age</subject><subject>Humans</subject><subject>Hypertension - epidemiology</subject><subject>Incidence</subject><subject>Logistic Models</subject><subject>Maternal Age</subject><subject>mean arterial blood pressure</subject><subject>Medical History Taking</subject><subject>Odds Ratio</subject><subject>Overweight - epidemiology</subject><subject>placental growth factor</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Pre-Eclampsia - prevention & control</subject><subject>preeclampsia</subject><subject>Pregnancy</subject><subject>Pregnancy Complications - epidemiology</subject><subject>Pregnancy Complications, Cardiovascular - epidemiology</subject><subject>Pregnancy Trimester, First</subject><subject>pregnancy-associated plasma protein-A</subject><subject>Premature Birth</subject><subject>Reproductive History</subject><subject>Reproductive Techniques, Assisted - utilization</subject><subject>Risk Assessment</subject><subject>Smoking - epidemiology</subject><subject>uterine artery Doppler</subject><issn>0002-9378</issn><issn>1097-6868</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNp9UcFu1DAQtRCILgs_wAH5yCWLnXgdB3EpVQtIleihnK2JPdn1KomD7SzqT_JNddiF3pCePH7ym6cZP0LecrbhjMsPhw0c_G5TMl5vWEalnpEVZ01dSCXVc7JijJVFU9XqgryK8bDQsilfkotS1UoIXq_I78s4ueBG2vlAr4_O4miw-AwRLb0LiKaHYYoOFnLEMTk_0hQc9B8pdh2aRH1H4eyRMT3J8kNmCcOw1CenrIpzuwt-nuIi-uUHHCkY44N1444mT9MeXaBmDwFMNnAxORMpjJYOaJ2B_s_dtzFhHmbh-6zx4eE1edFBH_HNua7Jj5vr-6uvxe33L9-uLm8LIxhLhbQVtCLPxFsJzKBqmMh_UpcGuGWVbAXfiqaTXJlt2QDbmpYzAbKppVTdFqs1eX_ynYL_OWNMenDRYN_DiH6OmjdlXTEh87km5Ulqgo8xYKen4AYID5ozveSoD3rJUS85apZRqdz07uw_t3nlfy1_g8uCTycB5i2PDoOOxi3ZWRdyKtp69z__R-BXtGA</recordid><startdate>201711</startdate><enddate>201711</enddate><creator>Poon, Liona C.</creator><creator>Wright, David</creator><creator>Rolnik, Daniel L.</creator><creator>Syngelaki, Argyro</creator><creator>Delgado, Juan Luis</creator><creator>Tsokaki, Theodora</creator><creator>Leipold, Gergo</creator><creator>Akolekar, Ranjit</creator><creator>Shearing, Siobhan</creator><creator>De Stefani, Luciana</creator><creator>Jani, Jacques C.</creator><creator>Plasencia, Walter</creator><creator>Evangelinakis, Nikolaos</creator><creator>Gonzalez-Vanegas, Otilia</creator><creator>Persico, Nicola</creator><creator>Nicolaides, Kypros H.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5856-6072</orcidid></search><sort><creationdate>201711</creationdate><title>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</title><author>Poon, Liona C. ; Wright, David ; Rolnik, Daniel L. ; Syngelaki, Argyro ; Delgado, Juan Luis ; Tsokaki, Theodora ; Leipold, Gergo ; Akolekar, Ranjit ; Shearing, Siobhan ; De Stefani, Luciana ; Jani, Jacques C. ; Plasencia, Walter ; Evangelinakis, Nikolaos ; Gonzalez-Vanegas, Otilia ; Persico, Nicola ; Nicolaides, Kypros H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c400t-6d3ab4eec1b6a0ce890428772ca1d036b41549f618c529a05cb104a697668f5e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Algorithms</topic><topic>aspirin</topic><topic>Aspirin - therapeutic use</topic><topic>ASPRE trial</topic><topic>Body Mass Index</topic><topic>chronic hypertension</topic><topic>Evidence-Based Medicine</topic><topic>Female</topic><topic>first-trimester screening</topic><topic>Gestational Age</topic><topic>Humans</topic><topic>Hypertension - epidemiology</topic><topic>Incidence</topic><topic>Logistic Models</topic><topic>Maternal Age</topic><topic>mean arterial blood pressure</topic><topic>Medical History Taking</topic><topic>Odds Ratio</topic><topic>Overweight - epidemiology</topic><topic>placental growth factor</topic><topic>Platelet Aggregation Inhibitors - therapeutic use</topic><topic>Pre-Eclampsia - prevention & control</topic><topic>preeclampsia</topic><topic>Pregnancy</topic><topic>Pregnancy Complications - epidemiology</topic><topic>Pregnancy Complications, Cardiovascular - epidemiology</topic><topic>Pregnancy Trimester, First</topic><topic>pregnancy-associated plasma protein-A</topic><topic>Premature Birth</topic><topic>Reproductive History</topic><topic>Reproductive Techniques, Assisted - utilization</topic><topic>Risk Assessment</topic><topic>Smoking - epidemiology</topic><topic>uterine artery Doppler</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Poon, Liona C.</creatorcontrib><creatorcontrib>Wright, David</creatorcontrib><creatorcontrib>Rolnik, Daniel L.</creatorcontrib><creatorcontrib>Syngelaki, Argyro</creatorcontrib><creatorcontrib>Delgado, Juan Luis</creatorcontrib><creatorcontrib>Tsokaki, Theodora</creatorcontrib><creatorcontrib>Leipold, Gergo</creatorcontrib><creatorcontrib>Akolekar, Ranjit</creatorcontrib><creatorcontrib>Shearing, Siobhan</creatorcontrib><creatorcontrib>De Stefani, Luciana</creatorcontrib><creatorcontrib>Jani, Jacques C.</creatorcontrib><creatorcontrib>Plasencia, Walter</creatorcontrib><creatorcontrib>Evangelinakis, Nikolaos</creatorcontrib><creatorcontrib>Gonzalez-Vanegas, Otilia</creatorcontrib><creatorcontrib>Persico, Nicola</creatorcontrib><creatorcontrib>Nicolaides, Kypros H.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of obstetrics and gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Poon, Liona C.</au><au>Wright, David</au><au>Rolnik, Daniel L.</au><au>Syngelaki, Argyro</au><au>Delgado, Juan Luis</au><au>Tsokaki, Theodora</au><au>Leipold, Gergo</au><au>Akolekar, Ranjit</au><au>Shearing, Siobhan</au><au>De Stefani, Luciana</au><au>Jani, Jacques C.</au><au>Plasencia, Walter</au><au>Evangelinakis, Nikolaos</au><au>Gonzalez-Vanegas, Otilia</au><au>Persico, Nicola</au><au>Nicolaides, Kypros H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>American journal of obstetrics and gynecology</jtitle><addtitle>Am J Obstet Gynecol</addtitle><date>2017-11</date><risdate>2017</risdate><volume>217</volume><issue>5</issue><spage>585.e1</spage><epage>585.e5</epage><pages>585.e1-585.e5</pages><issn>0002-9378</issn><eissn>1097-6868</eissn><abstract>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).
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.
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.
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).
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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28784417</pmid><doi>10.1016/j.ajog.2017.07.038</doi><orcidid>https://orcid.org/0000-0001-5856-6072</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0002-9378 |
| ispartof | American journal of obstetrics and gynecology, 2017-11, Vol.217 (5), p.585.e1-585.e5 |
| issn | 0002-9378 1097-6868 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1927304627 |
| source | ScienceDirect Freedom Collection 2022-2024 |
| subjects | Adult Algorithms aspirin Aspirin - therapeutic use ASPRE trial Body Mass Index chronic hypertension Evidence-Based Medicine Female first-trimester screening Gestational Age Humans Hypertension - epidemiology Incidence Logistic Models Maternal Age mean arterial blood pressure Medical History Taking Odds Ratio Overweight - epidemiology placental growth factor Platelet Aggregation Inhibitors - therapeutic use Pre-Eclampsia - prevention & control preeclampsia Pregnancy Pregnancy Complications - epidemiology Pregnancy Complications, Cardiovascular - epidemiology Pregnancy Trimester, First pregnancy-associated plasma protein-A Premature Birth Reproductive History Reproductive Techniques, Assisted - utilization Risk Assessment Smoking - epidemiology uterine artery Doppler |
| title | 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 |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-27T06%3A13%3A25IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Aspirin%20for%20Evidence-Based%20Preeclampsia%20Prevention%20trial:%20effect%20of%20aspirin%20in%20prevention%20of%20preterm%20preeclampsia%20in%20subgroups%20of%20women%20according%20to%20their%20characteristics%20and%20medical%20and%20obstetrical%20history&rft.jtitle=American%20journal%20of%20obstetrics%20and%20gynecology&rft.au=Poon,%20Liona%20C.&rft.date=2017-11&rft.volume=217&rft.issue=5&rft.spage=585.e1&rft.epage=585.e5&rft.pages=585.e1-585.e5&rft.issn=0002-9378&rft.eissn=1097-6868&rft_id=info:doi/10.1016/j.ajog.2017.07.038&rft_dat=%3Cproquest_cross%3E1927304627%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c400t-6d3ab4eec1b6a0ce890428772ca1d036b41549f618c529a05cb104a697668f5e3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1927304627&rft_id=info:pmid/28784417&rfr_iscdi=true |