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Am J Perinatol 2022; 39(13): 1396-1400
DOI: 10.1055/s-0041-1727215
Short Communication

Aspirin Responsiveness at a Dose of 80 mg and Its Impact on Birth Weight when Used in Twin Pregnancies: The GAP Pilot Randomized Trial

Caroline Carpentier
1   Centre de recherche du Centre Hospitalier, Universiatire de Québec-Université Laval, Axe Santé Reproduction Mère et Enfant, Québec, Canada
,
Paul Guerby 
1   Centre de recherche du Centre Hospitalier, Universiatire de Québec-Université Laval, Axe Santé Reproduction Mère et Enfant, Québec, Canada
,
Bruno Camiré
2   Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec, Canada
,
Sylvie Tapp
1   Centre de recherche du Centre Hospitalier, Universiatire de Québec-Université Laval, Axe Santé Reproduction Mère et Enfant, Québec, Canada
,
Amélie Boutin
1   Centre de recherche du Centre Hospitalier, Universiatire de Québec-Université Laval, Axe Santé Reproduction Mère et Enfant, Québec, Canada
3   Department of Pediatrics, Faculty of Medicine, Université Laval, Québec, Canada
,
Emmanuel Bujold 
1   Centre de recherche du Centre Hospitalier, Universiatire de Québec-Université Laval, Axe Santé Reproduction Mère et Enfant, Québec, Canada
2   Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec, Canada
› Author Affiliations Funding This study was supported by the Jeanne and Jean-Louis Levesque Perinatal Research Chair at Université Laval, Québec, Canada. E.B. holds a Clinician Scientist award from Fonds de recherche du Québec–Santé (FRQS), Québec, Canada. P.G. holds a postdoctoral Award from the FRQS and INSERM (Institut National de la Santé et de la Recherche Médicale). A.B. holds a Research Scholars Junior-1 Award from the FRQS.
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Abstract

Objective Daily aspirin, started in the first trimester of pregnancy, is commonly used for the prevention of preeclampsia and fetal growth restriction in multiple gestation. However, the optimal dose remains controversial and the evidence for the use of aspirin in multiple pregnancies is scarce. We aimed to estimate the impact of 80 mg of aspirin in twin pregnancies.

Study Design We performed a pilot double-blind randomized trial of women with twin pregnancies recruited between 8 and 14 weeks of gestation. Fifty participants (25 in each group) were randomized to 80 mg of aspirin daily at bedtime or a placebo from randomization until 36 weeks of gestation. Primary and secondary outcomes included the birth weight of live infants, preeclampsia, and aspirin responsiveness evaluated by a platelet aggregation test (platelet function assay [PFA]-100).

Results All participants were followed until birth, including 48 and 47 live newborns in the aspirin and the placebo groups, respectively. The mean birth weight difference between the aspirin (2,385 ± 529 g) and placebo (2,224 ± 706 g) groups was of 179 g (95% confidence interval [CI]: −172–531 g, p = 0.32). We observed two (8%) cases of preeclampsia in the aspirin group and no case with placebo (p = 0.49). Most importantly,16 of 24 participants who received aspirin (67%; 95% CI: 45–84%) had a normal PFA-100 test at 22 to 23 weeks, including the two cases of preeclampsia, suggesting that the majority of the participants were nonresponsive to 80 mg of aspirin.

Conclusion Our results suggest that the majority of women with twin pregnancies showed a lack of response to a daily dose of 80 mg of aspirin according to the PFA-100 test, compared with the expected 29% of nonresponsiveness in singleton pregnancies. A daily dose of 80 mg of aspirin is likely to be insufficient for the prevention of preeclampsia and other placenta-mediated complications in twin pregnancies.

Key Points

  • Most women with twin pregnancies are nonresponsive to a daily dose of 80-mg aspirin.

  • An 80 mg aspirin dose is insufficient to prevent placenta-mediated complications in twin pregnancies.

  • Randomized trials using 100 to 160 mg of aspirin in twin pregnancies are needed.

Keywords

aspirin - preeclampsia - fetal growth restriction - twin pregnancy - prevention


Publication History

Received: 05 June 2020

Accepted: 02 March 2021

Article published online:
21 April 2021

© 2021. Thieme. All rights reserved.

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