BJOG : an international journal of obstetrics and gynaecology · 2025
Impact of Aspirin on Timing of Birth in Pregnancies With Clinical Manifestations of Placental Dysfunction: Evidence From a Multicentre Randomised Clinical Trial.
СтатьяМногоцентровое исследованиеРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Papastefanou Ioannis, Chen Yunyu, Nguyen-Hoang Long, Nguyen Duy-Anh, Dinh Linh Thuy, Pooh Ritsuko K, Shiozaki Arihiro, Zheng Mingming, Hu Yali, Wu Yunping, Kusuma Aditya, Yapan Piengbulan, Choolani Mahesh A, Kaneko Mayumi, Luewan Suchaya, Chang Tung-Yao, Chaiyasit Noppadol, Nanthakomon Tongta, Jiang Yanmin, Shaw Steven W, Leung Wing Cheong, Mohamad Ainaa Syazana, Aguilar Angela, Lau So Ling, Lee Nikki M W, Tang Esther Wai Chi, Sahota Daljit S, Chong Marc K C, Poon Liona C
Аннотация
OBJECTIVE: To examine whether aspirin delays gestational age at delivery (GAD) in pregnancies with placental dysfunction (PD) phenotypes (preeclampsia [PE], small-for-gestational-age [SGA], placental abruption and/or stillbirth).
DESIGN: A secondary analysis of a multicentre stepped-wedge cluster randomised trial.
SETTING: 18 maternity/diagnostic units in Asia.
POPULATION: Singleton pregnancies examined at 11-13+6 weeks.
METHODS: A model in which the effect of aspirin is to delay the GAD in pregnancies with PD was developed.
MAIN OUTCOME MEASURES: GAD in pregnancies with PD.
RESULTS: Aspirin administration was associated with a significant reduction in PD < 32 weeks (adjusted relative risk 0.543, 95% CI: 0.330-0.864), with a trend for an increase of PD ≥ 32 weeks (test for trend, p-value = 0.0018). Similar findings were observed individually for PE, SGA and/or placental abruption. At 24 weeks, the aspirin-induced prolongation of pregnancies with PD was 2.85 weeks (95% CI: 0.44-5.40), and this effect was decreased by -0.19 weeks (95% CI: -0.33 to -0.05) for each week of gestation; therefore, at 28 and 32 weeks' gestation, the aspirin-induced prolongation was 2.09 and 1.33 weeks, respectively.
CONCLUSIONS: In this secondary analysis of a cluster randomised trial, women at high risk of PE who are destined to develop a clinical spectrum of PD may benefit from longer pregnancy duration through aspirin administration in early pregnancy. Aspirin may delay the GAD due to PD, particularly benefiting those deliveries that would occur at earlier gestations without aspirin administration.
DESIGN: A secondary analysis of a multicentre stepped-wedge cluster randomised trial.
SETTING: 18 maternity/diagnostic units in Asia.
POPULATION: Singleton pregnancies examined at 11-13+6 weeks.
METHODS: A model in which the effect of aspirin is to delay the GAD in pregnancies with PD was developed.
MAIN OUTCOME MEASURES: GAD in pregnancies with PD.
RESULTS: Aspirin administration was associated with a significant reduction in PD < 32 weeks (adjusted relative risk 0.543, 95% CI: 0.330-0.864), with a trend for an increase of PD ≥ 32 weeks (test for trend, p-value = 0.0018). Similar findings were observed individually for PE, SGA and/or placental abruption. At 24 weeks, the aspirin-induced prolongation of pregnancies with PD was 2.85 weeks (95% CI: 0.44-5.40), and this effect was decreased by -0.19 weeks (95% CI: -0.33 to -0.05) for each week of gestation; therefore, at 28 and 32 weeks' gestation, the aspirin-induced prolongation was 2.09 and 1.33 weeks, respectively.
CONCLUSIONS: In this secondary analysis of a cluster randomised trial, women at high risk of PE who are destined to develop a clinical spectrum of PD may benefit from longer pregnancy duration through aspirin administration in early pregnancy. Aspirin may delay the GAD due to PD, particularly benefiting those deliveries that would occur at earlier gestations without aspirin administration.