The effect of aspirin on the risk of preeclampsia based on the Fetal Medicine Foundation first-trimester risk
Notice bibliographique
Résumé
BACKGROUND: Aspirin reduces the risk of delivery with preterm preeclampsia among high-risk women, and such risk can be estimated in the first trimester of pregnancy using the Fetal Medicine Foundation algorithm by combining maternal factors with mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor. It is unclear whether the initial risk influences the effect of aspirin. OBJECTIVE: This study aimed to estimate the effect of aspirin on preeclampsia according to first-trimester risk. STUDY DESIGN: This was a post hoc secondary analysis of the Aspirin for Evidence-Based Preeclampsia Prevention trial, which randomized participants with a first-trimester risk of preeclampsia with delivery before 37 weeks of gestation (preterm preeclampsia) of ≥1 in 100 (or 1%), based on the Fetal Medicine Foundation algorithm, to receive aspirin 150 mg or placebo daily from 11 to 14 weeks to 36 weeks of gestation. The rates of preeclampsia, preterm preeclampsia, and early preeclampsia (with delivery before 34 weeks of gestation) were calculated according to the initial Fetal Medicine Foundation risk. Among participants with high compliance (≥90% of tablets prescribed) based on regular tablet counts, the effect of aspirin was estimated according to the initial Fetal Medicine Foundation risk. Relative risks with 95% confidence intervals were calculated. RESULTS: Of 822 participants in the placebo group, those with an initial Fetal Medicine Foundation risk of ≥1 in 20 (or >5%) had an overall rate of preeclampsia (21.7%), preterm preeclampsia (8.4%), and early preeclampsia (6.4%) significantly greater than those with an initial risk of <1 in 20 (8.1%, 2.9%, and 0.3%, respectively; all with P<.01). Of 1143 participants with high compliance randomized to aspirin or placebo, aspirin was associated with a reduction in preeclampsia at any gestation (relative risk, 0.64 [95% confidence interval, 0.44-0.93]), preterm preeclampsia (relative risk, 0.24 [95% confidence interval, 0.09-0.63]), and early preeclampsia (estimated relative risk, 0.06 [95% confidence interval, 0.01-0.96]) compared with placebo. Subgroup analyses enabled the identification of a differential response according to the initial Fetal Medicine Foundation risk. Among participants with an initial risk of ≥1 in 20, an absence (0.0%) of delivery with preeclampsia up to 35 weeks of gestation was observed in those randomized to aspirin compared with 6.1% in those randomized to placebo (estimated relative risk, 0.06 [95% confidence interval, 0.01-0.94]). In addition, it was observed that aspirin did not reduce significantly the preterm preeclampsia in this subgroup (relative risk, 0.47 [95% confidence interval, 0.17-1.34]). In contrast, when the initial risk was <1 in 20, aspirin was associated with an absence of delivery with preeclampsia up to 37 weeks of gestation compared with 2.5% with placebo (estimated relative risk, 0.05 [95% confidence interval, 0.01-0.78]). CONCLUSION: The first-trimester Fetal Medicine Foundation risk of preterm preeclampsia is associated with the risks of preeclampsia, preterm preeclampsia, and early preeclampsia. The prophylactic daily use of 150 mg aspirin, with compliance of ≥90%, can prevent almost all cases of preeclampsia with delivery up to 37 weeks of gestation when the initial risk is <1 in 20 and up to 35 weeks of gestation when the initial risk is ≥1 in 20 (≥5%). Women with an initial risk of ≥1 in 20 should be closely monitored from 34 to 35 weeks of gestation as they remain at risk of late preterm preeclampsia.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,009 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,003 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».