Re: Randomized controlled trial using low-dose aspirin in the prevention of pre-eclampsia in women with abnormal uterine artery Doppler at 23 weeks' gestation.

Abstract

Given the abundant literature already available concerning uterine artery velocimetry predictors and low-dose aspirin prevention of pre-eclampsia and complications of uteroplacental insufficiency, the design of the study recently published by Yu et al.1 was questionable in view of their objective. Indeed, it is now well demonstrated that an early diastolic notch in the uterine artery waveform is a better predictor of pre-eclampsia and complications of uteroplacental insufficiency than are other impedance indices2-5, and if the parameter is ‘persisting bilateral notching’ the negative predictive value of pre-eclampsia is very high (98%)3. Moreover, the positive predictive value of uterine artery Doppler is greater in pregnant women clinically at high risk for hypertensive disorders of pregnancy or intrauterine growth restriction6, and low-dose aspirin may be particularly justified in women with a past history of severe pre-eclampsia7. As Yu et al. excluded patients with pre-existing hypertensive or renal disease, included a proportion of 88% of participants without any (personal or family) history of pre-eclampsia, and took into account the absence of bilateral notching in one third of these participants, the definition of high risk was far from optimal. L. Carbillon*, M. Uzan*, * Department of Obstetrics and Gynecology, Jean-Verdier Hospital, Paris 13 University, Avenue du 14 Juillet—93143 Bondy Cedex