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.