Effect of Low-Dose Aspirin in Preventing Early-Onset Preeclampsia in the Taiwanese Population-A Retrospective Cohort Study

Purpose: To evaluate the effect of low-dose aspirin on preventing early-onset preeclampsia during first-trimester screening using maternal factors and biochemistry. Patients and Methods: This study was a retrospective cohort study of pregnant women with singleton pregnancies at a gestational age of 11-13+6 weeks from May 2017 to August 2019. Serum pregnancy-associated plasma protein A (PAPP-A)/placental growth factor (PLGF) and maternal demographic and clinical characteristics were collected and analyzed using a logistic regression model with a preset detection rate of 74% and a 10% false-positive rate. Low-dose aspirin was initiated for those screened positive for the prevention of early-onset preeclampsia. Results: Of the 805 women who underwent preeclampsia screening, 78 were screened positive for early-onset preeclampsia. With a preset detection rate of 74% and a 10% false-positive rate, there were a total of 28 women with preeclampsia, of which 11 developed preterm preeclampsia (<37 GA) and three had early-onset preeclampsia with 72% and 75% sensitivity and specificity of 93% and 91%, respectively, resulting in an estimated 95% risk reduction for early-onset preeclampsia. Early-onset preeclampsia had lower serum PLGF (0.29 multiple of the median [MoM], range 0.1-0.67) compared with preterm preeclampsia (0.74 MoM, range 0.1-2.26). PLGF remains the only predictor of early-onset preeclampsia, while mean arterial pressure and chronic hypertension are predictors of preterm preeclampsia using multivariate regression. No variables accurately predicted the development of early-onset preeclampsia with the initiation of low-dose aspirin before the gestational age of 16 weeks. Conclusion: A remarkable reduction in early-onset preeclampsia was observed with early initiation of low-dose aspirin in those screened positive for maternal characteristics and serum PAPP-A/PLGF.