Aspirin Discontinuation at 24-28 Weeks and Placental Biomarker Trajectories : Post Hoc Analysis of a Randomised Trial
Bonacina, Erika (Hospital Universitari Vall d'Hebron)
Armengol-Alsina, Mireia (Hospital Universitari Vall d'Hebron)
García Manau, Pablo (Hospital Universitari Vall d'Hebron)
Lopez Rodriguez, Monica (Hospital Universitari Joan XXIII de Tarragona)
Rodriguez-Zurita, Alicia (Hospital Universitario Nuestra Señora de Candelaria (Santa Cruz de Tenerife))
Vives, Àngels (Consorci Sanitari de Terrassa)
Lopez-Quesada, Eva (Hospital Universitari MútuaTerrassa (Terrassa, Catalunya))
Ricart, Marta (Universitat Autònoma de Barcelona. Departament de Pediatria, Obstetrícia i Ginecologia i de Medicina Preventiva i Salut Pública)
Maroto, Anna (Hospital Universitari de Girona Doctor Josep Trueta)
de Mingo, Laura (Hospital Universitario Severo Ochoa)
Pintado, Elena (Hospital Universitario de Getafe (Madrid))
Arias-Garcia, Andrea (Hospital Universitari Vall d'Hebron)
Martin, Lourdes (Hospital Universitari Joan XXIII de Tarragona)
Chulilla Perez, Carolina (Hospital Universitario Nuestra Señora de Candelaria (Santa Cruz de Tenerife))
Garcia Cancela, Esperanza (Consorci Sanitari de Terrassa)
Pallarols, Mar (Hospital Universitari MútuaTerrassa (Terrassa, Catalunya))
Vidal-Sagnier, Laia (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Teixidor, Mireia (Hospital Universitari de Girona Doctor Josep Trueta)
Orizales Lago, Carmen María (Hospital Universitario Severo Ochoa)
Pérez-Gomez, Adela (Hospital Universitario Nuestra Señora de Candelaria (Santa Cruz de Tenerife))
Ocaña, Vanesa (Hospital Universitario de Getafe (Madrid))
Puerto Tamayo, Linda Grace (Hospital Universitari Joan XXIII de Tarragona)
Millán, Pilar (Consorci Sanitari de Terrassa)
Diaz, Sonia (Hospital Universitario de Getafe (Madrid))
del Barco, Ester (Hospital Universitari Vall d'Hebron)
Dalmau, Marta (Hospital Universitari Vall d'Hebron)
Rolle, Valeria (Fundación iMaterna)
Carreras Moratonas, Elena (Hospital Universitari Vall d'Hebron)
Suy, Anna (Hospital Universitari Vall d'Hebron)
Mendoza, Manel (Universitat Autònoma de Barcelona. Departament de Pediatria, Obstetrícia i Ginecologia i de Medicina Preventiva i Salut Pública)

Data:	2025
Resum:	Objective: To compare the trajectories of placental biomarkers throughout pregnancy after aspirin discontinuation at 24-28 weeks with those of a cohort treated until 36 weeks of gestation. Design: A longitudinal secondary analysis of the StopPRE trial, using repeated measures of soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and their ratio. Setting: Nine maternity hospitals across Spain. Population: The original StopPRE trial included 936 women at high risk for preterm preeclampsia based on first-trimester screening. All participants received aspirin 150 mg daily until randomisation at 24-28 weeks. At that point, 463 women were assigned to continue aspirin until 36 weeks, while 473 were assigned to discontinue it. Methods: sFlt-1, PlGF, sFlt-1/PlGF were measured at baseline (24-28 weeks) and during follow-up visits at 28-32, 32-36, and after 36 weeks of gestation. Linear mixed-effects models (LMM) with treatment-by-gestational age interaction were used to analyze biomarker trajectories over time. Main Outcome Measures: Differences in trajectories of raw values and multiples of the median for sFlt-1, PlGF, sFlt-1/PlGF between groups. Results: Among 463 participants in the aspirin continuation group and 473 in the discontinuation group, 3483 measurements of each biomarker were analysed. There were no significant differences in the trajectories of sFlt-1, PlGF, or sFlt-1/PlGF between groups (p-values for raw analysis: 0. 662, 0. 728 and 0. 979, respectively). Conclusions: In women at high risk of preterm preeclampsia, discontinuing aspirin at 24-28 weeks did not alter the trajectories of placental biomarkers. This may explain why stopping aspirin did not increase preterm PE risk in the StopPRE trial.
Ajuts:	Instituto de Salud Carlos III PI17/01944
Nota:	Altres ajuts: acords transformatius de la UAB
Nota:	The trial was funded by the Instituto de Salud Carlos III (PI17/01944), the European Union (ERDF) and the Spanish Clinical Research Network (SCReN). Roche Diagnostics provided the regents. Funding:
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Aspirin ; Placental biomarkers ; PlGF ; Preeclampsia ; sFlt-1 ; sFlt-1/PlGF | sFt-1
Publicat a:	BJOG, Vol. 133, Num. 3 (February 2025) , p. 432-441, ISSN 1471-0528

DOI: 10.1111/1471-0528.70040
PMID: 41017450

10 p, 1.1 MB

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