Low-dose aspirin for pre-eclampsia prevention in twins with elevated human chorionic gonadotropin

OBJECTIVE: The objective of the study is to evaluate low-dose aspirin (LDA) for pre-eclampsia prevention in twin gestations with elevated maternal serum human chorionic gonadotropin (hCG). STUDY DESIGN: Secondary analysis of the Maternal-Fetal Medicine Units High-Risk Aspirin trial for pre-eclampsia prevention. A threshold hCG level for predicting pre-eclampsia was identified in placebo-randomized patients. Pre-eclampsia incidence and time of onset were compared between treatment groups, overall and by hCG threshold category. RESULTS: Pre-eclampsia incidence was lower with LDA than with placebo (6% vs 16%, OR 0.32, 95% CI 0.12 to 0.82). An hCG threshold of 29.96 IU ml(-1) best predicted pre-eclampsia. In patients with hCG < 29.96 IU ml(-1), the differences in pre-eclampsia incidence or time of onset were not significant. In patients with hCG > 29.96 IU ml(-1), LDA was associated with lower pre-eclampsia incidence than placebo (6% vs 23%, OR 0.21, 95% CI 0.06 to 0.79) and delayed onset. CONCLUSION: Twin gestations with elevated hCG levels may benefit from LDA for pre-eclampsia prevention.