Evaluation of the Effect of Low-Dose Aspirin on Biochemical and Biophysical Biomarkers for Placental Disease in Low-Risk Pregnancy: Secondary Analysis of a Multicenter RCT
Authors: Fionnuala Mone
Orla C Maguire
Philip Clarke
Eoghan E Mooney
Paul Downey
Fergal D Malone
David Fitzgerald
Cecilia Mulcahy
Fionnuala M McAuliffe
Peter McParland
Marie Culliton
Elizabeth Tully
Journal: American Journal of Perinatology (2019)
Discipline: CLINICAL MEDICINE
Keywords: aspirin use; low-risk pregnancy; PAPP-A; PLGF; urinary albumin-to-creatinine ratio
Affiliations: UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland, Department of Pathology and Laboratory Medicine, National Maternity Hospital, Dublin, Ireland, Department of Pharmacy, National Maternity Hospital, Dublin, Ireland, Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland

Abstract:  Objective: To assess the effect of aspirin use in low-risk pregnancy on: (1) pregnancy-associated plasma protein-A (PAPP-A) and placental-like growth factor (PLGF); (2) urinary albumin-to-creatinine ratio (ACR) and blood pressure; (3) fetal growth parameters; and (4) placental histopathology. Study design: This secondary analysis from the T rial of low-dose aspirin with an E arly S creening T est for preeclampsia and growth restriction randomized controlled trial was based on low-risk nulliparous women randomized at 11 weeks to (1) aspirin 75 mg; (2) no aspirin; and (3) aspirin based on the preeclampsia Fetal Medicine Foundation screening test. At baseline, women underwent assessment of blood pressure, PAPP-A, PLGF, and ACR, repeated 9 to 10 weeks postaspirin, in addition to fetal growth assessment. Gross and histopathological placental analyses were performed in line with Amsterdam criteria. Results: A total of 445 subjects were included (aspirin n = 163 [36.6%]; no aspirin n = 282 [63.4%]). Although the fetal-to-placental weight ratio was significantly greater in the aspirin group (7.5 [±1.3] vs. 7.3 [±1.4], p = 0.045), as was change in ultrasound assessed estimated fetal weight from second to third trimesters (1,624.5 g [±235.1] vs. 1,606.2 [±189.4], p = 0.042), this was invalidated by the lack of a difference in birth weight. Aspirin did not significantly impact on change in serum or urine preeclampsia biomarkers, maternal blood pressure, or placental histopathology. Conclusion: Aspirin use in low-risk pregnancy does not appear to impact on preeclampsia biomarkers, fetal growth, or placental pathology. 

Retracted: No

PubPeer comments:
 Dear authors, Thank you for an interesting paper! I noticed that Figure 1, showing the inclusion flow chart, conflicts with the numbers reported in the text; in Figure 1, 162 women are in the aspirin group and 283 women are in the nonaspirin group, whereas the text operates with 163 and 282 women, respectively. Although the error is unlikely to affect your results, group 3a is so small (N = 13) that the correct number should be given. Can the authors please confirm that the text is correct and that group 3a contained 13 women? , 
 In table 4, the denominator suddenly changes to 20 instead of 27 for villitis and delayed villous maturation in the aspirin group. The sum of examined pacentae is then lower than the 47 reported in the table and in the text. The percentages are calculated from 20, not 27, and if this is an error, it affects the odds ratio and perhaps the conclusion of the paper. Can the authors please clarify whether the table is correct? ![file] ,