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Diguisto C, Le Gouge A, Marchand MS, Megier P, Ville Y, Haddad G, Winer N, Arthuis C, Doret M, Debarge VH, Flandrin A, Delmas HL, Gallot D, Mares P, Vayssiere C, Sentilhes L, Cheve MT, Paumier A, Durin L, Schaub B, Equy V, Giraudeau B, Perrotin F. Low-dose aspirin to prevent preeclampsia and growth restriction in nulliparous women identified by uterine artery Doppler as at high risk of preeclampsia: A double blinded randomized placebo-controlled trial. PLoS One 2022; 17:e0275129. [PMID: 36260615 PMCID: PMC9581352 DOI: 10.1371/journal.pone.0275129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/08/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION This trial evaluates whether daily low-dose aspirin initiated before 16 weeks of gestation can reduce preeclampsia and fetal growth restriction in nulliparous women identified by first-trimester uterine artery Dopplers as at high risk of preeclampsia. METHODS This randomized, blinded, placebo-controlled, parallel-group trial took place in 17 French obstetric departments providing antenatal care. Pregnant nulliparous women aged ≥ 18 years with a singleton pregnancy at a gestational age < 16 weeks of gestation with a lowest pulsatility index ≥ 1.7 or a bilateral protodiastolic notching for both uterine arteries on an ultrasound performed between 11+0 and 13+6 weeks by a certified sonographer were randomized at a 1:1 ratio to 160 mg of low-dose aspirin or to placebo to be taken daily from inclusion to their 34th week of gestation. The main outcome was preeclampsia or a birthweight ≤ 5th percentile. Other outcomes included preeclampsia, severe preeclampsia, preterm preeclampsia, preterm delivery before 34 weeks, mode of delivery, type of anesthesia, birthweight ≤ 5th percentile and perinatal death. RESULTS The trial was interrupted due to recruiting difficulties. Between June 2012 and June 2016, 1104 women were randomized, two withdrew consent, and two had terminations of pregnancies. Preeclampsia or a birthweight ≤ 5th percentile occurred in 88 (16.0%) women in the low-dose aspirin group and in 79 (14.4%) in the placebo group (proportion difference 1.6 [-2.6; 5.9] p = 0.45). The two groups did not differ significantly for the secondary outcomes. CONCLUSION Low-dose aspirin was not associated with a lower rate of either preeclampsia or birthweight ≤ 5th percentile in women identified by their first-trimester uterine artery Doppler as at high risk of preeclampsia. TRIAL REGISTRATION (NCT0172946).
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Affiliation(s)
- Caroline Diguisto
- Pôle de Gynécologie Obstétrique, Médecine Fœtale, Médecine et Biologie de la Reproduction, Centre Olympe de Gouges, CHRU de Tours, Tours, France
- Université de Tours, Tours, France
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE,F, Paris, France
- * E-mail:
| | | | | | - Pascal Megier
- Department of Gynaecology and Obstetrics, Centre Hospitalier Régional d’Orléans, Orleans, France
| | - Yves Ville
- Centre de Dépistage PRIMA FACIE Université de Paris, Paris, France
- Maternité, AP-HP, Hôpital Necker, Paris, France
| | - Georges Haddad
- Cabinet Mosaïque Santé, La Chaussée Saint Victor, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, University Hospital of Nantes, Nantes, NUN, INRAE, UMR 1280, PhAN, Université de Nantes, Nantes, France
| | - Chloé Arthuis
- Department of Obstetrics and Gynecology, University Hospital of Nantes, Nantes, NUN, INRAE, UMR 1280, PhAN, Université de Nantes, Nantes, France
| | - Muriel Doret
- Service de Gynécologie-Obstétrique, HFME, Hospices Civils de Lyon, Lyon, France
| | - Veronique Houfflin Debarge
- Department of Obstetrics, CHU Lille, Univ. Lille, ULR 2694—METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Anaig Flandrin
- Service de Gynécologie-Obstétrique, Hôpital Arnaud de Villeneuve, CHRU de Montpellier, Montpellier, France
| | - Hélène Laurichesse Delmas
- Service de Gynécologie-Obstétrique, Hôpital d’Estaing, CHU de Clermont-Ferrand, Maternité Clermont Ferrand, Clermont-Ferrand, France
| | - Denis Gallot
- Service de Gynécologie-Obstétrique, Hôpital d’Estaing, CHU de Clermont-Ferrand, Maternité Clermont Ferrand, Clermont-Ferrand, France
| | - Pierre Mares
- Département de Gynécologie Obstétrique, Centre Hospitalo-Universitaire Caremeau, Nîmes, France
- École de Maïeutique, Université de Montpellier, Site de Nîmes, Nîmes, France
| | - Christophe Vayssiere
- Department of Obstetrics and Gynaecology, Paule de Viguier Hospital, Toulouse University Hospital Center, Toulouse, France
- Centre for Epidemiology and Population Health Research, Team SPHERE, Toulouse III University, Toulouse, France
| | - Loïc Sentilhes
- Service de Gynécologie-Obstétrique, Groupe Hospitalier Pellegrin, CHRU de Bordeaux, Talence, France
| | | | - Anne Paumier
- Service de Gynécologie-Obstétrique, Polyclinique de l’Atlantique, Saint-Herblain, France
| | - Luc Durin
- Service de Gynécologie-Obstétrique, Polyclinique du Parc, Caen, France
| | - Bruno Schaub
- Service de Gynécologie-Obstétrique, Maison de la Femme, de la Mère et de l’Enfant, CHU Martinique, Fort-de-France, Martinique, France
| | - Veronique Equy
- Service de Gynécologie-Obstétrique, Hôpital Couple Enfant, CHRU de Grenoble, La Tronche, France
| | - Bruno Giraudeau
- Université de Tours, Tours, France
- INSERM CIC1415, CHRU de Tours, Tours, France
| | - Franck Perrotin
- Pôle de Gynécologie Obstétrique, Médecine Fœtale, Médecine et Biologie de la Reproduction, Centre Olympe de Gouges, CHRU de Tours, Tours, France
- Université de Tours, Tours, France
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