Getty Images. Recommended standard of care. Should it be standard treatment? Read this next. Aspirin May Reduce Stroke Risk for Women with Preeclampsia History A new study found that aspirin may help women whose history of preeclampsia at risk for serious cardiac events. New Urine Test Could Diagnose Preeclampsia Earlier Researchers say a timely diagnosis can help pregnant women get quicker treatment for the potentially deadly ailment. Preeclampsia: Second Pregnancy Risks.
Medically reviewed by Karen Gill, M. Recent studies suggest that low-dose "baby" aspirin could prevent pregnancy loss and preeclampsia. So does that mean you should start taking it if you're expecting a baby or trying to get pregnant? We broke down the latest research. A recent study from the National Institutes of Health, published in Annals of Internal Medicine , found that taking low-dose aspirin while trying to conceive and throughout pregnancy might benefit those who previously suffered miscarriages.
Researchers studied the effect of low-dose aspirin on 1, women aged 18 to 40—all of whom experienced one or two pregnancy losses in the past. It found that participants who took milligram of low-dose aspirin five to seven days per week had "8 more hCG-detected pregnancies , 15 more live births, and 6 fewer pregnancy losses for every women in the trial," compared with those who took a placebo, according to the report. The same effects were found in those who took baby aspirin four days per week.
These results contradict a previous large randomized trial, which didn't find any link between baby aspirin and pregnancy results. But this trial was "subject to nonadherence," according to Annals of Internal Medicine , and researchers re-analyzed data from women who strictly adhered to the aspirin dosage. What is AFLP? Data shows the continued critical need for all pregnant women, regardless of trimester, to receive the influenza vaccination, according to an updated Committee Opinion released by the American Colle Last Updated on July 13, Who should consider taking prenatal aspirin?
When should I start taking low-dose aspirin? Does it matter what time of day I take my dose? What are the risks associated with taking prenatal aspirin? Its report found: No increase in infant loss, growth problems, or cognition harm to the baby; No statistically significant impact on risk of placental abruptions, postpartum hemorrhage bleeding , or miscarriage to the mother; No differences in developmental outcomes of the infants up to age 18 months.
No studies have followed the offspring of preeclamptic women on aspirin beyond 18 months. Can taking low-dose aspirin increase my risk of miscarriage? Will aspirin hurt the baby? When should I stop taking low-dose aspirin? Do I need to consult a healthcare provider before starting low-dose aspirin? Where can I get low-dose aspirin? Does taking aspirin guarantee that preeclampsia will be prevented or delayed? Preeclampsia Posparto July 29, Covid and Preeclampsia August 12, Top 10 Tips for Telehealth November 17, Stillbirth and preeclampsia share many of the same risk factors, and when stillbirth is related to placental dysfunction, the underlying mechanisms are also likely similar.
Few studies have focused solely on the effect of low-dose aspirin prophylaxis on stillbirth. In one early nonrandomized trial, investigators reported a nearly twofold increase in live births when low-dose aspirin was given to women with at least one prior pregnancy loss at more than 13 weeks of gestation and a negative result on antiphospholipid antibody testing Findings were similar in a retrospective cohort study of women with prior fetal loss at more than 10 weeks of gestation However, the results of prospectively collected stillbirth data from RCTs and meta-analyses designed to study the use of low-dose aspirin for preeclampsia prevention are inconclusive 12 13 Until additional supportive evidence becomes available, low-dose aspirin prophylaxis is not recommended solely for the indication of prior unexplained stillbirth in the absence of risk factors for preeclampsia.
Low-dose aspirin prophylaxis for prevention of recurrent fetal growth restriction is similarly not currently recommended in women without other risk factors for preeclampsia because of insufficient evidence in women with an isolated history of fetal growth restriction. However, in women at risk of preeclampsia, prophylaxis with low-dose aspirin particularly when initiated less than 16 weeks of gestation may reduce the risk of fetal growth restriction.
Abnormal placentation resulting in poor placental perfusion ie, placental insufficiency is the most common pathology associated with fetal growth restriction Some investigators have suggested that low-dose aspirin, initiated early in the first trimester, may prevent fetal growth restriction through its inhibitory action on platelet aggregation and improvement in placental development 43 One study first reported that low-dose aspirin, in combination with dipyridamole, significantly reduced the incidence of recurrent fetal growth restriction Although this outcome was confirmed in a subsequent meta-analysis, the study did not identify which women were most likely to benefit from low-dose aspirin There are currently no well-powered RCTs evaluating the role of low-dose aspirin in the prevention of recurrent fetal growth restriction in otherwise low-risk women.
Evidence as to whether starting low-dose aspirin before 16 weeks of gestation influences the degree to which low-dose aspirin is beneficial in reducing fetal growth restriction is inconclusive, though some meta-analyses have suggested improved benefit with earlier initiation 29 30 31 Currently, because the majority of evidence supporting a reduction of fetal growth restriction from low-dose aspirin prophylaxis comes from studies of women who were also at risk of preeclampsia—not with histories of fetal growth restriction alone—there is insufficient evidence to support the use of low-dose aspirin for fetal growth restriction prophylaxis in the absence of other risk factors for preeclampsia.
The effect of low-dose aspirin on preterm birth as a primary outcome remains understudied. However, until evidence from high-quality studies directed towards prevention of spontaneous preterm birth become available, low-dose aspirin prophylaxis for prevention of spontaneous preterm birth, in the absence of risk factors for preeclampsia, is not recommended. Aspirin has been shown to decrease uterine contractility by inhibiting COX-dependent prostaglandin synthesis High doses of aspirin have been studied to treat preterm labor, but the irreversible binding to COX-2 and adverse maternal and fetal effects of high-dose aspirin prohibit its use in the clinical setting.
However, whether this reflects a reduction in medically indicated or spontaneous preterm births is not clear in most studies. A recent systematic review and meta-analysis 48 analyzed individual patient data from 17 trials of preeclampsia prevention 28, participants that supplied sufficient detail regarding whether delivery was spontaneous or medically indicated.
Another study using data from a randomized controlled trial of low-dose aspirin versus placebo given to women with a history of pregnancy loss reported that low-dose aspirin, started before pregnancy and continued through pregnancy, was not associated with a reduction in overall preterm births RR, 0.
The combination of low-dose aspirin and unfractionated or low-molecular-weight heparin has been shown to reduce the risk of early pregnancy loss in women with antiphospholipid syndrome However, low-dose aspirin has not been shown to prevent unexplained early pregnancy loss in women who do not have antiphospholipid syndrome.
Pooling data from two trials participants , one study reported no increase in live births among women treated with low-dose aspirin compared with placebo RR: 0. Based on the available evidence, the use of low-dose aspirin prophylaxis is not recommended for the prevention of early pregnancy loss. Women at risk of preeclampsia are defined based on the presence of one or more high-risk factors history of preeclampsia, multifetal gestation, renal disease, autoimmune disease, type 1 or type 2 diabetes, and chronic hypertension or more than one moderate-risk factor first pregnancy, maternal age of 35 years or older, a body mass index greater than 30, family history of preeclampsia, sociodemographic characteristics, and personal history factors Table 1.
In the absence of high-risk factors for preeclampsia, current evidence does not support the use of prophylactic low-dose aspirin for the prevention of early pregnancy loss, fetal growth restriction, stillbirth, or preterm birth. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care.
It is not intended to substitute for the independent professional judgment of the treating clinician. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology.
The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence.
Any updates to this document can be found on www. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented.
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