247. Effect of aspirin on soluble Fms-like tyrosine kinase-1 levels and placental growth factor in women with suspected or confirmed preeclampsia

Abstract

Background Patients with preeclampsia display elevated placenta-derived sFlt-1 (soluble Fms-like tyrosine kinase-1) and decreased placental growth factor (PlGF) levels. Low-dose aspirin use is recommended for the prevention of preeclampsia in high-risk women, although its exact pathogenic mechanism remains unknown. Preclinical studies have shown that aspirin decreases sFlt-1 secretion in vitro. Our aim is to investigate whether aspirin use affects sFlt-1 and PlGF in women with confirmed or suspected preeclampsia. Methods A prospective cohort study was conducted involving 430 women. Of these women, 45 took aspirin for 10 to 32 (median 23) days before sFlt-1 and PlGF measurement. Measurements were only made once at study entry, between weeks 20 and 41 (median 33) weeks. Results Women using aspirin at study entry were compared to either all women not using aspirin, or given that sFlt-1 and PlGF alter with advancing gestation, to gestational age-matched women not using aspirin. We aimed at obtaining 2 gestational age-matched non-users for each individual drug user. Aspirin use tended to lower sFlt-1/PlGF ratio (p = 0.05), but this trend was mitigated when matched with gestational age-matched controls (p > 0.05). With regard to other drugs affecting sFlt-1, PPI use was associated with lower sFlt-1 levels both when compared with all non-PPI users and with 80 gestational age-matched controls. No sFlt-1/PlGF factor alterations were observed in women using ferrous fumarate or macrogol while, and as expected, women using antihypertensive medication displayed higher sFlt-1 levels and lower PlGF levels. The PPI use-associated decrease in sFlt-1 was independent of the application of aspirin or antihypertensive drugs. Rates of pregnancy complications for aspirin users were not different from non-aspirin users. Discussion Treatment with aspirin does not associate with lower sFlt-1 or altered PlGF levels. Larger studies are required to further elucidate the pathogenic role of aspirin in the prevention of preeclampsia.