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DOES ASPIRIN PREVENT PREECLAMPSIA IN HEALTHY WOMEN?

Preeclampsia is characterized by an excess of thromboxane A2 over prostacyclin, causing vasoconstriction and platelet activation. Low-dose aspirin can prevent preeclampsia in high-risk women by inhibiting the production of thromboxane (see Journal Watch accession number 890818003). This large multicenter study examined the effects of low-dose aspirin in healthy women.

The authors randomized 3135 normotensive, nulliparous women who were 13 to 26 weeks pregnant to receive aspirin (60 mg daily) or placebo. The incidence of preeclampsia was marginally lower with aspirin than with placebo (4.6 vs. 6.3 percent), but more women in the aspirin group developed abruptio placentae (0.7 vs. 0.1 percent). There were no differences between groups in birth weight or rates of fetal growth retardation, postpartum hemorrhage, or neonatal bleeding. Preeclampsia developed mainly in women whose initial systolic blood pressure was 120 to 134 mm Hg (5.6 vs. 11.9 percent in the aspirin and placebo groups, respectively).

Comment: Unfortunately, the clinical implications of this study are unclear. Patient taking low-dose aspirin had a lower preeclampsia rate, but it was of borderline statistical significance and was accompanied by a higher rate of abruptio placentae. The benefits of aspirin were more apparent in women with borderline elevations of systolic blood pressure.

— ALK

Published in Journal Watch General Medicine November 2, 1993

Citation(s):

Zuspan FP; Samuels P. Preventing preeclampsia. N Engl J Med 1993 Oct 21 329 1265-1266.

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• Medline abstract (Free)

Sibai BM et al. Prevention of preeclampsia with low-dose aspirin in healthy, nulliparous pregnant women. N Engl J Med 1993 Oct 21 329 1213-1218.

• Original article (Subscription may be required)
• Medline abstract (Free)