The ASPRE trial evaluated the use of low-dose aspirin for prevention of preterm pre-eclampsia. At what gestational age should aspirin be initiated, and what is the recommended dose according to this trial protocol?
- A 11–13+6 weeks; 75 mg daily
- B 16–20 weeks; 100 mg daily
- C 11–13+6 weeks; 150 mg daily at night ✓
- D 20 weeks; 81 mg daily
Correct answer: C. 11–13+6 weeks; 150 mg daily at night
Explanation
The ASPRE trial (2017) was a multicenter RCT that enrolled high-risk women identified by first-trimester combined screening (uterine artery Doppler, MAP, PlGF, PAPP-A). Aspirin 150 mg taken at bedtime was initiated between 11 and 13+6 weeks. Bedtime administration was chosen because aspirin better inhibits platelet thromboxane production during the absorptive phase when platelets are made overnight. The trial showed a 62% reduction in preterm pre-eclampsia (<37 weeks) in high-risk women. Current FIGO guidelines recommend this protocol for first-trimester-identified high-risk cases.
Reference: Williams Obstetrics, 26th ed.
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