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Hypertension

Poster Session 1

(253) Aspirin dose effect on uterine artery Doppler in patients stratified by biomarkers: ASPERIN secondary analysis

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: To determine if there is a dose-effect of aspirin on uterine artery Doppler over time, when groups were stratified by Fetal Medicine Foundation (FMF) criteria to define risk for preeclampsia.

Study Design: This was a planned secondary analysis of The ASpirin in Placental and maternal Endothelial cell Regulation IN pre-eclampsia (ASPERIN) trial which enrolled a study population as high versus low risk based on the United States Preventive Services Task Force (USPSTF) major criteria. We reclassified the entire population by FMF guidelines with a cutoff of less than 1:100 for further analysis. Criteria for discrimination included mean arterial pressure (MAP), uterine artery pulsatility index (UtA PI), and clinical factors in the first trimester before initiation of treatment. High risk subjects were randomly assigned to 81 mg versus 162 mg daily aspirin in the parent trial. UtA PI was measured at baseline to define risk and subsequently at 20-22 weeks and 28-32 weeks. A mixed model analysis was performed to assess for dose-response, with ANOVA, T test and nonparametric analyses performed where applicable.

Results: Of the 209 patients enrolled in the ASPERIN Trial, 57 assigned to 81 mg, 54 to 162 mg aspirin, and 16 controls were restratified as high risk. Demographics differed between subgroups (see table). In the model, significant interactions were identified in UtA PI related to treatment group (p=0.0002), risk calculation (p=< 0.0001), and time, (p< 0.0001). First and second trimester UtA PI did not differ between aspirin subgroups by dose (p=0.160 and p=0.153, respectively). A significant difference was noted in the third trimester between the subgroups (p=0.024). The difference between enrollment and third trimester UtA PI was significantly greater in the 81 mg group versus 162 mg (0.766 and 0.573, respectively, p=0.040). 

Conclusion: A dose-effect of aspirin on UtA PI was identified over time, supporting evidence this biomarker is informative in assessing treatment response when discriminating candidates for therapy based on FMF criteria.