Are there ongoing clinical trials for preeclampsia prevention?

Ongoing Clinical Trials for Preeclampsia Prevention

Yes, there are several ongoing clinical trials for preeclampsia prevention, with research focusing on optimal aspirin dosing, calcium supplementation, and novel biomarker-based approaches.

Current Prevention Strategies

Low-Dose Aspirin

• Currently the best-studied preventive strategy for preeclampsia 1
• USPSTF and ACOG recommend 81 mg/day for high-risk women 1, 2
• Should be initiated between 12-16 weeks of gestation and continued until delivery 1, 3
• Reduces preeclampsia risk by 24%, preterm birth by 14%, and intrauterine growth restriction by 20% 1

Calcium Supplementation

• WHO recommends 1.5-2.0g elemental calcium daily from 20 weeks gestation for women with low calcium intake 3
• Reduces preeclampsia risk by approximately 50% in women with low dietary calcium intake 3
• Should be taken in divided doses of ≤500mg for optimal absorption 3

Ongoing Research and Clinical Trials

Aspirin Dosing Studies

• Recent trials are comparing different aspirin doses for preeclampsia prevention
• The ASPREO trial (2025) is comparing 162mg vs 81mg aspirin in high-risk obese individuals 4
  • Preliminary results show a 78% probability of benefit with the higher dose
  • 12% reduction in preeclampsia with severe features when using 162mg compared to 81mg

Novel Prevention Approaches

Several experimental approaches are being investigated:

1. Biomarker-Based Risk Stratification

   • Studies using uterine artery pulsatility index, mean arterial pressure, pregnancy-associated plasma protein A, PlGF, and sFlt-1 1
   • Machine learning approaches for early detection and subtyping 1

2. Therapeutic Interventions Under Investigation

   • Pravastatin (though initial studies did not show significant pregnancy prolongation) 1
   • Dextran sulfate apheresis to reduce circulating sFlt-1 (exploratory pilot studies) 1
   • Metformin (may extend gestation by 1 week in preeclampsia patients) 1

Research Challenges and Future Directions

Challenges in Preeclampsia Research

• Heterogeneity of preeclampsia subtypes complicates study design 1
• Need for larger randomized controlled trials with populations characterized by preeclampsia subtype 1
• Many interventions promising in preclinical or small pilot studies have proven ineffective in larger randomized trials 1

Future Research Priorities

1. Elucidating pathways leading to various preeclampsia subtypes 1
2. Developing targeted prevention strategies based on preeclampsia subtype 1
3. Including diverse patient populations to understand variations in normal and complicated pregnancies 1
4. Designing strategies applicable to low- and middle-income countries where disease burden is highest 1

Clinical Implications

For women at high risk of preeclampsia (history of preeclampsia, multifetal gestation, renal disease, autoimmune disease, diabetes, or chronic hypertension), current evidence supports:

1. Low-dose aspirin (81mg daily) starting before 16 weeks gestation 1, 2
2. Calcium supplementation (1.5-2.0g daily) particularly for those with low dietary calcium intake 3
3. Regular monitoring with appropriate laboratory investigations 3

While research continues to advance our understanding of preeclampsia prevention, these established interventions remain the cornerstone of prevention for high-risk women.