Effect of Aspirin on Biomarker Profile in Women at High Risk for Preeclampsia
This prospective longitudinal nested case-control study conducted in Hong Kong involved 2,007 singleton pregnant women, including high-risk and low-risk groups for preterm preeclampsia. High-risk women received aspirin prophylaxis (100 or 160 mg daily depending on weight) starting before 16 weeks until 36 weeks or delivery. The study aimed to assess the temporal changes of key preeclampsia-related biomarkers—mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), placental growth factor (PlGF), and soluble fms-like tyrosine kinase-1 (sFlt-1)—across gestation, comparing high-risk women who developed preeclampsia, those who did not, and low-risk women without aspirin.
Key findings highlight that despite aspirin prophylaxis, women who developed preeclampsia maintained consistently higher MAP from the first trimester and exhibited pronounced biomarker abnormalities: elevated UtA-PI and lowered PlGF starting from the second trimester, and increased sFlt-1 in the third trimester. Aspirin did not normalize blood pressure but influenced the biomarker trajectories in those not developing preeclampsia. These results underscore the role of these biomarkers for ongoing risk stratification and monitoring in high-risk pregnant women and suggest that biomarker profiles could help tailor aspirin treatment duration.
Key Findings
Study Population: 403 low-risk women, 1,471 high-risk without preeclampsia, 133 high-risk with preeclampsia.
Aspirin Use: Administered based on weight, started <16 weeks gestation, continued until 36 weeks or delivery.
Biomarker Trends
High-risk women with preeclampsia had higher MAP levels consistently from the first trimester.
Elevated UtA-PI and lowered PlGF began in the second trimester in preeclamptic women.
Increased sFlt-1 levels appeared in the third trimester in the preeclampsia group.
Biomarker Trajectories
Low-risk women showed normal biomarker patterns; aspirin normalized some markers in high-risk women who did not develop preeclampsia.
Clinical Implications
Monitoring these biomarkers could improve risk stratification and guide personalized management of aspirin therapy among high-risk pregnancies.
Limitations
No high-risk group without aspirin for comparison, some missing data due to preterm delivery or missed visits.
"Aspirin alters biomarker trajectories but does not normalize blood pressure in high-risk pregnancies; biomarker monitoring is key for preeclampsia risk stratification."
