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Aspirin and preterm preeclampsia prevention are critical areas of focus for improving maternal health. Preterm preeclampsia (PE) is a serious condition affecting pregnant women worldwide, with potentially severe consequences for both mother and child. A study in East Asia has revealed that a first-trimester screening strategy, combined with low-dose aspirin, can significantly reduce the risk of preterm PE in high-risk women.

Understanding preeclampsia

Preeclampsia is a hypertensive multi-system disorder during pregnancy characterised by high blood pressure and often elevated protein levels in the urine. Symptoms can include swelling, kidney dysfunction, and shortness of breath. The disorder is categorised by gestational age at birth into early (< 34 weeks), preterm (< 37 weeks), and term PE (> 37 weeks), with early and preterm forms linked to more severe complications, such as fetal growth restriction, low birth weight, or stillbirth.

The screening-and-prevention strategy

The study utilised a two-phase approach: a non-intervention phase with routine antenatal care and an intervention phase that included comprehensive first-trimester screening. Researchers identified high-risk pregnancies using maternal characteristics and biomarkers, such as mean arterial pressure and placental growth factor. In the intervention group, they offered low-dose aspirin to women identified as high-risk to reduce their chances of developing preterm PE.

High acceptance and effective prevention

Nearly 40000 women from different East Asian countries and ethnic backgrounds with a viable singleton pregnancy took part in this study. Participants largely accepted the screening, with only 12% declining. Among those identified as high-risk, over 80% opted to take low-dose aspirin. The results demonstrated a significant reduction in preterm PE incidence compared to routine antenatal care, ranging from 41% to 48% when compliance was over ≥ 90%. Alternatively, the screening-and-prevention strategy without aspirin demonstrated comparable PE incidence to routine antenatal care, highlighting its potential effectiveness.

Safe and well-tolerated

Researchers confirmed the safety of low-dose aspirin, reporting minimal side effects such as heartburn or vaginal bleeding (less than 1%). The study also highlighted additional benefits, such as reduced rates of perinatal death and stillbirth. These findings are consistent with previous research, confirming aspirin’s effectiveness as a preventive measure against PE during pregnancy.

Implications for global health

The success of this study in an Asian context suggests that the screen-and-prevent strategy could be effectively implemented worldwide. Researchers advocate exploring alternative therapies for those unresponsive to aspirin. They emphasize the need for a more personalized approach to preventing preterm PE. This study underscores the potential of targeted interventions to improve maternal and fetal health. It also supports the broader adoption of similar strategies worldwide.

Paper available at: PEC Innovation (Implementation of First-trimester Screening and Prevention of Preeclampsia: a Stepped Wedge Cluster-randomized Trial in Asia – PubMed (nih.gov))

Full list of authors: Long Nguyen-Hoang, Linh Thuy Dinh, Angela S T Tai, Duy-Anh Nguyen, Ritsuko K Pooh, Arihiro Shiozaki, Mingming Zheng, Yali Hu, Bin Li, Raden Aditya Kusuma, Piengbulan Yapan, Arundhati Gosavi, Mayumi Kaneko, Suchaya Luewan, Tung-Yao Chang, Noppadol Chaiyasit, Tongta Nanthakomon, Huishu Liu, Steven W Shaw, Wing Cheong Leung, Zaleha Abdullah Mahdy, Angela Aguilar, Hillary H Y Leung, Nikki M W Lee, So Ling Lau, Isabella Y M Wah, Xiaohong Lu, Daljit S Sahota, Marc K C Chong, Liona C Poon

DOI: https://doi.org/10.1161/CIRCULATIONAHA.124.069907