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Sir,

The benefits associated with the use of aspirin in women with abnormal uterine artery Dopplers, as found by Vainio et al.1, are consistent with a meta-analysis we recently published2. Before this trial1, there were five randomised trials3–7, which evaluated the effect of aspirin to prevent pre-eclampsia in women identified to be at high risk with an abnormal uterine artery Doppler test. Of these, four trials3–5,7 showed a trend towards benefit, but in three4,5,7, the sample size was not large enough to produce significant P values. One trial6 showed a statistically non-significant trend towards harm. However, with meta-analysis of all five trials, we were able to demonstrate a statistically significant benefit of aspirin in preventing pre-eclampsia, although our estimation of average effect was relatively imprecise (pooled odds ratio = 0.55, 95% CI 0.32–0.95, P= 0.03)2.

With the current trial1, we have updated our meta-analysis2 (see Fig. 1) and found results to be supportive of the editorial viewpoint: ‘aspirin does reduce the risk of pre-eclampsia’8. There is now substantial evidence that aspirin is of benefit among women with abnormal uterine artery Doppler. Therefore, this test and treatment combination should now be considered for incorporation into clinical practice in high risk women8. There is a tendency for apathy among clinicians towards implementing treatments recently shown to be effective. There are several examples of this; steroids for respiratory distress syndrome is only one example. We hope this mistake will not occur with aspirin therapy to prevent pre-eclampsia in women with abnormal uterine artery Doppler.

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Figure 1. Meta-analysis of randomised trials of aspirin to prevent pre-eclampsia in women with abnormal uterine artery Doppler. χ2 test for heterogeneity was not significant.

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References

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  2. References
  • 1
    Vainio M, Kujansuu E, Iso-Mustajarvi M, Maenpaa J. Low dose acetylsalicylic acid in prevention of pregnancy-induced hypertension and intrauterine growth retardation in women with bilateral uterine artery notches. Br J Obstet Gynaecol 2002;109(2):161167.
  • 2
    Coomarasamy A, Papaioannou S, Gee H, Khan KS. Aspirin for the prevention of preeclampsia in women with abnormal uterine artery Doppler: a meta-analysis. Obstet Gynecol 2001;98: 861866.
  • 3
    McParland P, Pearce JM, Chamberlain GV. Doppler ultrasound and aspirin in recognition and prevention of pregnancy-induced hypertension. Lancet 1990;335: 15521555.
  • 4
    Morris JM, Fay RA, Ellwood DA, Cook CM, Devonald KJ. A randomized controlled trial of aspirin in patients with abnormal uterine artery blood flow. Obstet Gynecol 1996;87: 7478.
  • 5
    Bower SJ, Harrington KF, Schuchter K, McGirr C, Campbell S. Prediction of pre-eclampsia by abnormal uterine Doppler ultrasound and modification by aspirin. Br J Obstet Gynaecol 1996;103: 625629.
  • 6
    Zimmermann P, Eirio V, Koskinen J, et al. Effect of low-dose aspirin treatment on vascular resistance in the uterine, uteroplacental, renal and umbilical arteries—a prospective longitudinal study on a high risk population with persistent notch in the uterine arteries. Eur J Ultrasound 1997;5: 1730.
  • 7
    Harrington K, Kurdi W, Aquilina J, England P, Campbell S. A prospective management study of slow-release aspirin in the palliation of uteroplacental insufficiency predicted by uterine artery Doppler at 20 weeks. Ultrasound Obstet Gynecol 2000;15: 1318.
  • 8
    Grant JM. Aspirin does reduce the risk of pre-eclampsia (Editor's Choice). Br J Obstet Gynaecol 2002;109(2):105.