Just How Bad Is Missing a Few Preeclampsia Prophylaxis Doses?

March 03, 2020 7:58 AM | Becca Liebers (Administrator)

MedPage Today

Study details aspirin nonadherence impacts on obstetric complications

Greater aspirin adherence was associated with better preeclampsia prevention in high-risk pregnancies, according to an observational cohort study.

Inadequate adherence, seen in 63 of 145 women prescribed prophylactic aspirin in the study from Australia, was linked to a higher incidence of:

Early-onset preeclampsia (17% vs 2% with adequate adherence, OR 1.9, 95% CI 1.1-8.7)

Late-onset preeclampsia (41% vs 5%, OR 4.2, 95% CI 1.4-19.8)

Intrauterine growth restriction (29% vs 5%, OR 5.8, 95% CI 1.2-8.3)

Preterm delivery (27% vs 10%, OR 5.2, 95% CI 1.5-8.7)

Increase in antihypertensive use antenatally (60% vs 10%, OR 4.6, 95% CI 1.2-10.5)

Good aspirin compliance was linked to lower odds of premature delivery -- the only treatment for preeclampsia -- on Kaplan-Meier analysis (HR 0.3, 95% CI 0.2-0.5), a study team led by Renuka Shanmugalingam, MBBS, of Liverpool Hospital in Australia, reported online in the Hypertension journal.

With an absolute risk reduction of 51% and number needed to treat of just two when adherence is ≥90%, the authors concluded that aspirin is "an effective prophylactic agent" for the prevention of preeclampsia.

"Therefore, suggesting adequate adherence with aspirin is essential and that nonadherence with aspirin among high-risk pregnant women may result in preventable obstetric complications," they urged.

They acknowledged, however, that aspirin for preeclampsia prophylaxis "remains controversial" because of conflicting data.

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