Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.
RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Aust N Z J Obstet Gynaecol. 2021 Jun;61(3):347-353. doi: 10.1111/ajo.13284. Epub 2020 Dec 16.
Aspirin has been shown to reduce prevalence of both early-onset pre-eclampsia (ePET) and fetal growth restriction (FGR).
To determine whether aspirin prescribed for risk of ePET reduces the prevalence of small for gestational age (SGA) neonates.
Two prospective cohorts were consecutively recruited in a large university hospital in Sydney. The Observational cohort (April 2010 to March 2012) validated an algorithm for ePET screening, where risk for ePET was modelled on history, mean arterial pressure, uterine artery pulsatility index and pregnancy-associated plasma protein A. The Interventional cohort (April 2012 to December 2017) were screened and allocated women at high risk of developing ePET to aspirin 150 mg. The prevalence of preterm and term SGA was compared using regression analysis.
There were 3013 and 8424 women screened in the Observational and Interventional cohorts respectively. Women who screened high risk for ePET were three to four times more likely to give birth to a neonate classified as SGA in the Observational (6.8% vs 1.9%) and Interventional cohorts (6.0% vs 1.8%). In women who screened high risk, there were no statistically significant differences in the prevalence of SGA neonates (6.6% vs 6.0%; adjusted odds ratio 0.84 (0.50-1.42)) in women who received aspirin compared to women who did not.
Women who screen high risk for ePET have an increased chance of delivering an SGA infant. A reduction in the prevalence of SGA neonates when aspirin was prescribed to women who screened high risk for ePET did not reach clinical significance in our cohort.
阿司匹林已被证明可降低早发型子痫前期（ePET）和胎儿生长受限（FGR）的发生率。
确定用于预防 ePET 风险的阿司匹林是否会降低小于胎龄儿（SGA）新生儿的发生率。
在悉尼的一家大型大学医院连续招募了两个前瞻性队列。观察队列（2010 年 4 月至 2012 年 3 月）验证了 ePET 筛查的算法，其中 ePET 的风险是基于病史、平均动脉压、子宫动脉搏动指数和妊娠相关血浆蛋白 A 来建模的。干预队列（2012 年 4 月至 2017 年 12 月）进行了筛查，并将高危发生 ePET 的妇女分配接受阿司匹林 150mg 治疗。使用回归分析比较了早产和足月 SGA 的发生率。
观察队列和干预队列分别有 3013 名和 8424 名妇女接受了筛查。在观察队列和干预队列中，筛查出 ePET 风险高的妇女，其分娩出 SGA 新生儿的可能性是筛查出低风险妇女的三到四倍（6.8% vs 1.9%；6.0% vs 1.8%）。在筛查出高风险的妇女中，与未接受阿司匹林治疗的妇女相比，接受阿司匹林治疗的妇女中 SGA 新生儿的发生率没有统计学上的显著差异（6.6% vs 6.0%；调整后的优势比为 0.84（0.50-1.42））。
筛查出 ePET 风险高的妇女分娩 SGA 婴儿的几率增加。在我们的队列中，对筛查出 ePET 风险高的妇女开具阿司匹林并未降低 SGA 新生儿的发生率，且未达到临床意义。
