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Should I Take Baby Aspirin for High Blood Pressure

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Committee on Obstetric Do

Society for Maternal–Fetal Medicine:

This Commission Opinion was adult by the Committee on Obstetric Practice in collaboration with committee member T. Flint Porter, MD, and the Club for Maternal–Fetal Medicine in collaboration with members Cynthia Gyamfi-Bannerman, MD, MS, and Tracy Manuck, MD.

ABSTRACT: Low-dose aspirin has been used during pregnancy, near commonly to prevent or filibuster the onset of preeclampsia. The American Higher of Obstetricians and Gynecologists issued the Hypertension in Pregnancy Job Force Study recommending daily low-dose aspirin kickoff in the late outset trimester for women with a history of early-onset preeclampsia and preterm commitment at less than 34 0/7 weeks of gestation, or for women with more than ane prior pregnancy complicated by preeclampsia. The U.S. Preventive Services Task Force published a similar guideline, although the list of indications for low-dose aspirin use was more than expansive. Daily low-dose aspirin use in pregnancy is considered prophylactic and is associated with a low likelihood of serious maternal, or fetal complications, or both, related to use. The American Higher of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine support the U.Due south. Preventive Services Job Force guideline criteria for prevention of preeclampsia. Low-dose aspirin (81 mg/day) prophylaxis is recommended in women at high risk of preeclampsia and should be initiated between 12 weeks and 28 weeks of gestation (optimally before 16 weeks) and continued daily until commitment. Low-dose aspirin prophylaxis should be considered for women with more than one of several moderate risk factors for preeclampsia. Women at risk of preeclampsia are defined based on the presence of ane or more high-risk factors (history of preeclampsia, multifetal gestation, renal affliction, autoimmune disease, type ane or type 2 diabetes, and chronic hypertension) or more than one of several moderate-adventure factors (starting time pregnancy, maternal age of 35 years or older, a body mass index greater than xxx, family unit history of preeclampsia, sociodemographic characteristics, and personal history factors). 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 nativity.

Recommendations

The American Higher of Obstetricians and Gynecologists (ACOG) and the Society for Maternal–Fetal Medicine make the following recommendations:

  • Low-dose aspirin (81 mg/solar day) prophylaxis is recommended in women at high adventure of preeclampsia and should be initiated between 12 weeks and 28 weeks of gestation (optimally before xvi weeks) and continued daily until delivery.

  • Depression-dose aspirin prophylaxis should be considered for women with more than one of several moderate risk factors for preeclampsia.

  • Low-dose aspirin prophylaxis is non recommended solely for the indication of prior unexplained stillbirth, in the absence of risk factors for preeclampsia.

  • Low-dose aspirin prophylaxis is not recommended for prevention of fetal growth brake, in the absence of risk factors for preeclampsia.

  • Low-dose aspirin prophylaxis is not recommended for the prevention of spontaneous preterm birth, in the absence of risk factors for preeclampsia.

  • Low-dose aspirin prophylaxis is non recommended for the prevention of early on pregnancy loss.

Introduction

Aspirin is a cyclooxygenase inhibitor with antiinflammatory and antiplatelet properties. Low-dose aspirin has been used during pregnancy virtually unremarkably to prevent or delay the onset of preeclampsia. Other suggested indications for low-dose aspirin have included prevention of stillbirth, fetal growth brake, preterm birth, and early pregnancy loss. Recent systematic reviews of low-dose aspirin utilise during pregnancy have improved our understanding of the part of depression-dose aspirin in each of these clinical situations. Despite this, the employ of low-dose aspirin in clinical obstetrics practise remains varied. The purpose of this certificate is to summarize the bear witness and provide current recommendations regarding the use of low-dose aspirin in pregnancy. It should be noted that although systematic reviews and consensus statements have used different doses of low-dose aspirin, this document will consider only the low-dose aspirin bachelor in the United States (81 mg).

Background

In November 2013, ACOG issued the Hypertension in Pregnancy Task Strength Study recommending daily low-dose aspirin beginning in the late kickoff trimester for women with a history of early-onset preeclampsia and preterm delivery at less than 34 0/7 weeks of gestation, or for women with more than one prior pregnancy complicated past preeclampsia 1. The following year, the U.S. Preventive Services Job Force (USPSTF) published a like guideline, although the list of indications for low-dose aspirin use was more than expansive Tabular array 1 2. The USPSTF guideline too suggested that depression-dose aspirin be considered in women with "several" moderate gamble factors for preeclampsia Table 1.

Low-Dose Aspirin Use During Pregnancy

Other wellness care organizations as well have published guidelines for preeclampsia prevention using low-dose aspirin based on hazard factors. Published in 2011, the Globe Health System guideline recommended that low-dose aspirin (75 mg/day) be initiated before 20 weeks of gestation for women at high risk of preeclampsia; eg, women with a history of preeclampsia, diabetes, chronic hypertension, renal disease, autoimmune disease, and multiple gestations 3. The National Establish of Wellness and Care Excellence published a quality statement, Antenatal Assessment of Pre-eclampsia Risk, in July 2013 that asked health care providers to prescribe low-dose aspirin (75 mg/day) to pregnant women at increased risk of preeclampsia at the showtime prenatal visit, to be taken daily from 12 weeks of gestation until nascency 4. The caste of risk of preeclampsia was based on the presence of one or more loftier-risk factors (hypertensive disease in previous pregnancy, chronic kidney illness autoimmune disease, type 1 or blazon 2 diabetes, and chronic hypertension) or more than ane moderate-risk cistron (first pregnancy, maternal age of twoscore years or older, a body mass index greater than 35, family history of preeclampsia, and multiple pregnancy) 4.

Pathophysiology

Aspirin (acetylsalicylic acid) is a nonsteroidal antiinflammatory drug (NSAID) that works primarily through its inhibition of two cyclooxygenase isoenzymes (COX-1 and COX-2), which are necessary for prostaglandin biosynthesis. The COX-one isoform is present in the vascular endothelium and regulates the product of prostacyclin and thromboxane A 2, prostaglandins with opposing regulatory effects on vascular homeostasis and platelet office. Prostacyclin is a potent vasodilator and inhibitor of platelet aggregation, whereas thromboxane A 2 (TXA2) is a strong vasoconstrictor and promotes platelet assemblage. The COX-ii isoform is inducible and expressed almost exclusively following exposure to cytokines or other inflammatory mediators. The effect of aspirin on COX-dependent prostaglandin synthesis is dose dependent. At lower dosages (60–150 mg/solar day) aspirin irreversibly acetylates COX-one, resulting in decreased platelet synthesis of TXA2 without affecting vascular wall production of prostacyclin 5 6. At higher doses, aspirin inhibits both COX-one and COX-2, finer blocking all prostaglandin product.

Evidence suggesting that an imbalance in prostacyclin and TXA2 metabolism was involved in the evolution of preeclampsia prompted the initial studies of aspirin for preeclampsia prevention because of its preferential inhibition of TXA2 at lower doses 7 8. Still, it is likely that preeclampsia is a issue of poor placentation from a diversity of causes, including ischemia, reperfusion, or dysfunctional maternal inflammatory response towards the trophoblast 1 ix. Whether depression-dose aspirin improves early placental perfusion is unknown, and also, the precise mechanism by which low-dose aspirin prevents preeclampsia in some women is too uncertain 10 eleven.

Risks of Aspirin Utilize in Pregnancy

Maternal Risks

The bulk of systematic reviews of randomized controlled trials (RCTs) have found no increment in hemorrhagic complications associated with low-dose aspirin during pregnancy 12 13 14. A USPSTF study on low-dose aspirin for prevention of preeclampsia identified no increased risk of placental abruption (11 trials [23,332 women]; relative chance [RR], 1.17; CI, 0.93–1.48), postpartum hemorrhage (nine trials [22,760 participants]; RR, 1.02; CI, 0.96–1.09), or mean blood loss (five trials, [ii,478 women]; RR not reported) 14. Long-term daily aspirin use in non-pregnant adults (less than 300 mg/solar day for more than 5 years) has been associated with an increased hazard of major gastrointestinal and cerebral bleeding episodes fifteen. In one RCT of low-dose aspirin during pregnancy for the prevention of preeclampsia, transfusion risk was slightly greater in treated patients, (4.0% versus three.two%) 16.

Fetal Risks

Several systematic reviews of trials using low-dose aspirin for prevention of preeclampsia take shown no increased adventure of congenital anomalies 12 13 14. Moreover, a contempo RCT of 1,228 women, 615 of whom received low-dose aspirin showtime before pregnancy and continuing throughout pregnancy, found no increased take chances of adverse fetal or neonatal effects associated with low-dose aspirin exposure 17. The number of congenital malformations too was not found to be increased among a accomplice of nearly 15,000 women who reported aspirin employ during the commencement trimester 18. Still, business organization has been raised most a possible association betwixt aspirin use during pregnancy and gastroschisis 19 20 21. A meta-analysis that included v case–control studies suggested that a history of aspirin utilise was twice as common in women with infants with gastroschisis compared with matched controls without gastroschisis 22. However, these data should be interpreted with extreme caution. In this meta-analysis, the dose of aspirin was not indicated (thus it is not clear whether this applies to the use of low-dose aspirin), the study evaluated women using aspirin in the start trimester only and is discipline to recall bias, and there were a number of variables not controlled, including use of other licit and illicit drugs in these trials.

The use of low-dose aspirin (60–150 mg) in the third trimester has not been associated with ductal closure 23 24. Older animal studies suggested a relationship between in utero exposure to NSAIDs in general and premature closure of the ductus arteriosus resulting in persistent pulmonary hypertension in the neonate 25. Still, in contrast to this and other studies that did not differentiate type of dose of NSAID exposure, no increase in perinatal deaths from persistent pulmonary hypertension in the neonate has been reported among more than 30,000 women treated in RCTs involving the study of depression-dose aspirin versus placebo for effect on a variety of outcomes 12 14 26.

The most recent Cochrane meta-analysis did not find an increased adventure of neonatal intracranial hemorrhage (10 trials [26,184 infants]) or other neonatal hemorrhagic complications (8 trials [27,032 infants]) associated with maternal ingestion of depression-dose aspirin during the tertiary trimester 12. Assay of pooled data in the USPSTF systematic review was likewise reassuring, with no increment in intracerebral hemorrhage associated with low-dose aspirin utilise during pregnancy (10 RCTs [22,158 women]; RR, 0.84; CI, 0.61–1.sixteen) xiv.

Contraindications to Aspirin Use During Pregnancy

At that place are few absolute contraindications to aspirin therapy 27. Patients with a history of aspirin allergy (eg, urticaria) or hypersensitivity to other salicylates are at chance of anaphylaxis and should not receive low-dose aspirin. Because of significant cross-sensitivity betwixt aspirin and other nonsteroidal drugs, depression-dose aspirin is likewise contraindicated in patients with known hypersensitivity to NSAIDs. Exposure to low-dose aspirin in patients with nasal polyps may result in life-threatening bronchoconstriction and should exist avoided. The aforementioned is true in patients with asthma who accept a history of aspirin-induced acute bronchospasm 27. Relative contraindications to depression-dose aspirin include a history of gastrointestinal bleeding, active peptic ulcer illness, other sources of gastrointestinal or genitourinary bleeding, and severe hepatic dysfunction. Reye syndrome has been reported rarely (less than 1%) in children younger than 18 years who are given aspirin while recovering from viral illnesses, particularly influenza and chickenpox. The decision to continue low-dose aspirin in the presence of obstetric bleeding or risk factors for obstetric bleeding should be considered on a instance-by-case basis.

Timing of Use During Pregnancy

With the exception of studies of low-dose aspirin for prevention of early pregnancy loss, the majority of trials using low-dose aspirin during pregnancy take initiated treatment between 12 weeks and 28 weeks of gestation. Some investigators accept reported optimal results merely when treatment is started before 16 weeks 28 29 30 31. A recent meta-assay of aggregate information from 45 randomized trials reported merely a minor reduction in preeclampsia when low-dose aspirin was started subsequently 16 weeks (RR, 0.81; CI, 0.66–0.99) but pregnant reductions in astringent preeclampsia (RR, 0.47; CI, 0.26–0.83) and fetal growth restriction (RR, 0.56; CI, 0.44–0.lxx) were demonstrated when low-dose aspirin was started earlier 16 weeks 31. In another meta-analysis, which included information from the contempo Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Testify-Based Preeclampsia Prevention trial, the authors reported a reduction in preterm preeclampsia only in the subgroup of patients in which aspirin was initiated before sixteen weeks of gestation at a daily dose of 100 mg or more (RR, 0.33; 95% CI, 0.19–0.57) thirty. In contrast, another study pooled individual information from 31 loftier-quality randomized trials and found that the beneficial effects of low-dose aspirin were consistent, whether treatment was started earlier or after xvi weeks of gestation 32.

There is no apparent benefit to stopping depression-dose aspirin before delivery. Study protocols specific to pregnancy have varied, with some discontinuing depression-dose aspirin at 36 weeks of gestation and others standing depression-dose aspirin until delivery 14 33 34 35. Discontinuation timing has not been related to excessive maternal or fetal bleeding. Likewise, low-dose aspirin use in the absence of other anticoagulants is not a contraindication to neuraxial blockade 36. Some patients nowadays to care in the first trimester on low-dose aspirin. Whether first-trimester exposure is associated with agin fetal effects or maternal benefit is not known.

Indications for Low-Dose Aspirin During Pregnancy

Prevention of Preeclampsia

The hypothesis that preeclampsia might be associated with vascular disturbances and coagulation defects resulting from an imbalance in prostacyclin and TXA2 led to the initial studies of aspirin for preeclampsia prevention. The results of several minor trials suggested that low-dose aspirin may be benign for women at high risk of preeclampsia 37 viii. However, until recently, this finding was not confirmed in larger RCTs xvi 33 38, including a multicenter trial sponsored past the Eunice Kennedy Shriver National Institute of Child Health and Human Development, which included more than 5,000 women 33. The 2017 Aspirin for Evidence-Based Preeclampsia Prevention trial randomized 1,776 women at loftier risk of preeclampsia based on a first-trimester screening algorithm to 150-mg aspirin or placebo 39. The authors found a meaning decrease in the rate of preterm preeclampsia (4.three% versus one.6%; odds ratio, 0.38; 95% CI, 0.20–0.74). Although the 150-mg dose was used in this study, there are no available studies comparing lx–80 mg versus 150 mg. Farther, the screening algorithm used includes kickoff-trimester serum markers, including placental growth gene and pregnancy-associated plasma poly peptide-A, as well as uterine artery dopplers, which limits the generalizability to a U.S. population. Therefore, a higher dose or doubling of the bachelor 81-mg dose cannot be recommended at this time.

A meta-analysis pooling individual patient data from 31 RCTs showed a modest upshot of depression-dose aspirin prophylaxis on prevention of preeclampsia in groups of women with diverse risk profiles (RR, 0.90; 95% CI, 0.84–0.97) 13. A subsequent Cochrane review, which pooled aggregate data from 59 trials, reported a 17% relative reduction in preeclampsia with low-dose aspirin use 12. However, this large take a chance reduction may reflect publication bias (a small, early positive trial is more than likely to exist published) or hazard findings considering the largest trials in the assay showed no significant protective effect.

The 2014 USPSTF guideline on depression-dose aspirin for prevention of morbidity and bloodshed from preeclampsia is based on the findings of their systematic review, which pooled data from 15 loftier-quality RCTs, xiii of which reported preeclampsia incidence among women considered at highest adventure of affliction Tabular array i 2. A 24% reduction in preeclampsia (RR, 0.76; CI, 0.62–0.95) with low-dose aspirin prophylaxis (60–150 mg/day) was demonstrated fourteen. However, the authors suggested this dramatic reduction in relative run a risk might be closer to 10% because of "pocket-sized report effects" of most of the included trials. Depending on baseline preeclampsia chance, the relative risk reduction with low-dose aspirin was associated with a small decrease in an absolute risk reduction of 2–5%.

Based on the findings from the USPSTF and others, depression-dose aspirin prophylaxis (81 mg/twenty-four hour period) later on 12 weeks of gestation modestly reduces the take chances of preeclampsia in women at increased run a risk, without resulting in adverse fetal effects, increased maternal bleeding, or placental abruption. The recommendation to give depression-dose aspirin prophylaxis to loftier-take chances women is based on the number needed to treat in private hazard groups, which in plough is based on illness prevalence and treatment result. In depression-hazard groups (disease prevalence of 2%), the number needed to treat is approximately 500, compared with a number needed to care for of fifty women in a high-take chances group with a disease prevalence of 20%. The USPSTF guideline recommends giving low-dose aspirin after 12 weeks of gestation to women with an absolute risk of preeclampsia of at least viii%, the lowest incidence of preeclampsia in control groups of studies included in their review 2. Based on historic and demographic risk factors, the USPSTF guideline recommends that women with whatsoever of the high-risk factors for preeclampsia should receive low-dose aspirin prophylaxis. Depression-dose aspirin prophylaxis should be considered in women with more than than i of several moderate adventure factors for preeclampsia Tabular array 1.

The American College of Obstetricians and Gynecologists and the Gild for Maternal-Fetal Medicine back up the USPSTF guideline criteria for prevention of preeclampsia. Low-dose aspirin (81 mg/day) prophylaxis is recommended in women at loftier take chances of preeclampsia and should exist initiated betwixt 12 weeks and 28 weeks of gestation (optimally before xvi weeks) and continued daily until delivery. Women who were receiving medically-indicated low-dose aspirin for other established medical indications before 12–28 weeks may continue with low-dose aspirin handling.

Bereft Testify for Low-Dose Aspirin

Stillbirth

Low-dose aspirin prophylaxis is not recommended for women with a history of stillbirth in the absence of take chances factors for preeclampsia. Stillbirth and preeclampsia share many of the same chance factors, and when stillbirth is related to placental dysfunction, the underlying mechanisms are also probable similar. Few studies accept focused solely on the event of depression-dose aspirin prophylaxis on stillbirth. In ane early on nonrandomized trial, investigators reported a nigh twofold increase in alive 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 antibiotic testing 40. Findings were similar in a retrospective cohort study of 230 women with prior fetal loss at more than x weeks of gestation 41. Notwithstanding, the results of prospectively collected stillbirth data from RCTs and meta-analyses designed to report the use of low-dose aspirin for preeclampsia prevention are inconclusive 12 13 fourteen. 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 chance factors for preeclampsia.

Fetal Growth Restriction

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 bereft show in women with an isolated history of fetal growth restriction. Nonetheless, in women at risk of preeclampsia, prophylaxis with low-dose aspirin (especially when initiated less than sixteen 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 42. Some investigators have suggested that depression-dose aspirin, initiated early in the first trimester, may forbid fetal growth restriction through its inhibitory activeness on platelet aggregation and improvement in placental development 43 44. I study beginning reported that low-dose aspirin, in combination with dipyridamole, significantly reduced the incidence of recurrent fetal growth restriction 45. Although this effect was confirmed in a subsequent meta-analysis, the study did not identify which women were most likely to benefit from low-dose aspirin 46. At that place are currently no well-powered RCTs evaluating the role of low-dose aspirin in the prevention of recurrent fetal growth restriction in otherwise depression-risk women. Systematic reviews of depression-dose aspirin when used in the setting of preeclampsia prevention have consistently reported a 10–20% reduction in fetal growth restriction or infants who were small for gestational age 12 13 14 29 30 31 32. Prove as to whether starting depression-dose aspirin before 16 weeks of gestation influences the degree to which low-dose aspirin is benign in reducing fetal growth restriction is inconclusive, though some meta-analyses have suggested improved benefit with earlier initiation 29 30 31 32. Currently, considering the bulk of evidence supporting a reduction of fetal growth restriction from depression-dose aspirin prophylaxis comes from studies of women who were as well at run a risk of preeclampsia—not with histories of fetal growth restriction alone—in that location is insufficient testify to support the use of low-dose aspirin for fetal growth brake prophylaxis in the absenteeism of other risk factors for preeclampsia.

Preterm Birth

The consequence of depression-dose aspirin on preterm birth as a master outcome remains understudied. All the same, until prove from high-quality studies directed towards prevention of spontaneous preterm nativity 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 past inhibiting COX-dependent prostaglandin synthesis 47. High doses of aspirin take been studied to treat preterm labor, but the irreversible binding to COX-2 and agin maternal and fetal furnishings of high-dose aspirin prohibit its employ in the clinical setting. Low-dose aspirin has been reported to reduce preterm birth (at less than 37 weeks of gestation) in 8–fourteen% of women at risk of preeclampsia 12 xiii 14 32. However, whether this reflects a reduction in medically indicated or spontaneous preterm births is not clear in nigh studies. A recent systematic review and meta-analysis 48 analyzed individual patient data from 17 trials of preeclampsia prevention (28,797 participants) that supplied sufficient detail regarding whether delivery was spontaneous or medically indicated. In that study, treatment with depression-dose aspirin resulted in a 7% reduction in the risk of spontaneous preterm nascence at fewer than 37 weeks (RR, 0.93; 95% CI, 0.86–0.996) and a 14% reduction in spontaneous preterm birth at fewer than 34 weeks (RR, 0.86; 95% CI, 0.76–0.99) compared with controls. Spontaneous preterm nascence at fewer than 28 weeks was reduced by xix%, only the difference was not statistically pregnant (RR, 0.81; 95% CI, 0.59–ane.1) 48. Some other written report 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 connected through pregnancy, was not associated with a reduction in overall preterm births (RR, 0.72; 95% CI, 0.42–1.23), spontaneous preterm nascence (RR, 0.51; 95% CI, 0.nineteen–ane.34), or medically indicated preterm nascency (RR, 0.89; 95% CI, 0.44–1.80) 49.

Indications for Which In that location Is No Benefit for Depression-Dose Aspirin

Early Pregnancy Loss

The combination of low-dose aspirin and unfractionated or depression-molecular-weight heparin has been shown to reduce the take a chance of early on pregnancy loss in women with antiphospholipid syndrome 50. However, low-dose aspirin has not been shown to prevent unexplained early pregnancy loss in women who practise not take antiphospholipid syndrome. Pooling data from two trials (256 participants), one report reported no increase in live births among women treated with low-dose aspirin compared with placebo (RR: 0.94, CI, 0.fourscore–one.11) 51. A 2014 study also reported no difference in live births when 1,078 women with one or two prior pregnancy losses were given depression-dose aspirin or placebo before pregnancy (58% versus 53%, P=.0984). Pregnancy loss occurred in 13% of 535 women given low-dose aspirin compared with 12% of 543 women in the placebo grouping ( P=.7812) 35. Based on the available testify, the use of low-dose aspirin prophylaxis is non recommended for the prevention of early pregnancy loss.

Conclusions

Daily low-dose aspirin use in pregnancy is considered safe and is associated with a low likelihood of serious maternal, or fetal complications, or both, related to apply. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine support the USPSTF guideline criteria for prevention of preeclampsia. Low-dose aspirin (81 mg/d) prophylaxis is recommended in women at loftier chance of preeclampsia and should be initiated betwixt 12 weeks and 28 weeks of gestation (optimally before xvi weeks) and continued daily until delivery. Low-dose aspirin prophylaxis should be considered for women with more than one of several moderate risk factors for preeclampsia. Women at take a chance of preeclampsia are defined based on the presence of 1 or more high-risk factors (history of preeclampsia, multifetal gestation, renal illness, autoimmune disease, type ane or type ii diabetes, and chronic hypertension) or more than one moderate-adventure factor (first pregnancy, maternal age of 35 years or older, a torso mass alphabetize greater than 30, family history of preeclampsia, sociodemographic characteristics, and personal history factors) Table 1. In the absence of high-take chances factors for preeclampsia, current evidence does non back up the use of prophylactic low-dose aspirin for the prevention of early pregnancy loss, fetal growth brake, stillbirth, or preterm nascence.

References

  1. American College of Obstetricians and Gynecologists. Hypertension in pregnancy . Washington, DC: American College of Obstetricians and Gynecologists; 2013. Available at: http://www.acog.org/Resources-And-Publications/Chore-Forcefulness-and-Piece of work-Group-Reports/Hypertension-in-Pregnancy. Retrieved Jan 24, 2018.
    Article Locations:
  2. LeFevre ML. Depression-dose aspirin utilise for the prevention of morbidity and mortality from preeclampsia: U.S. Preventive Services Task Strength recommendation statement. U.Southward. Preventive Services Task Force. Ann Intern Med 2014; 161: 819– 26.
    Article Locations:
  3. World Wellness Organisation. WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia . Geneva (Switzerland): WHO; 2011. Available at: http://apps.who.int/iris/bitstream/10665/44703/1/9789241548335_eng.pdf. Retrieved January 24, 2018.
    Article Locations:
  4. National Found for Health and Care Excellence. Hypertension in pregnancy: quality standard . Manchester (Britain): NICE; 2013. Bachelor at: https://www.nice.org.great britain/guidance/qs35/resource/hypertension-in-pregnancy-2098607923141. Retrieved January 26, 2018.
    Article Locations:
  5. Clarke RJ, Mayo G, Toll P, FitzGerald GA. Suppression of thromboxane A2 but not of systemic prostacyclin past controlled-release aspirin. Northward Engl J Med 1991; 325: 1137– 41.
    Article Locations:
  6. Patrono C. Aspirin as an antiplatelet drug. N Engl J Med 1994; 330: 1287– 94.
    Article Locations:
  7. Benigni A, Gregorini Yard, Frusca T, Chiabrando C, Ballerini S, Valcamonico A, et al. Upshot of low-dose aspirin on fetal and maternal generation of thromboxane by platelets in women at gamble for pregnancy-induced hypertension. Northward Engl J Med 1989; 321: 357– 62.
    Article Locations:
  8. Schiff E, Peleg Due east, Goldenberg M, Rosenthal T, Ruppin Due east, Tamarkin 1000, et al. The utilize of aspirin to prevent pregnancy-induced hypertension and lower the ratio of thromboxane A2 to prostacyclin in relatively loftier chance pregnancies. N Engl J Med 1989; 321: 351– half dozen.
    Article Locations:
  9. Sibai B, Dekker Grand, Kupferminc M. Pre-eclampsia. Lancet 2005; 365: 785– 99.
    Article Locations:
  10. Coomarasamy A, Papaioannou South, Gee H, Khan KS. Aspirin for the prevention of preeclampsia in women with aberrant uterine avenue Doppler: a meta-analysis. Obstet Gynecol 2001; 98: 861– 6.
    Commodity Locations:
  11. Scazzocchio E, Oros D, Diaz D, Ramirez JC, Ricart Grand, Meler Eastward, et al. Touch on of aspirin on trophoblastic invasion in women with abnormal uterine artery Doppler at xi–fourteen weeks: a randomized controlled report. Ultrasound Obstet Gynecol 2017; 49: 435– 41.
    Article Locations:
  12. Duley L, Henderson-Smart DJ, Meher S, King JF. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD004659.
    Commodity Locations:
  13. Askie LM, Duley L, Henderson-Smart DJ, Stewart LA. Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. PARIS Collaborative Grouping. Lancet 2007; 369: 1791– 8.
    Article Locations:
  14. Henderson JT, Whitlock EP, O'Connor Due east, Senger CA, Thompson JH, Rowland MG. Depression-dose aspirin for prevention of morbidity and bloodshed from preeclampsia: a systematic show review for the U.S. Preventive Services Chore Strength. Ann Intern Med 2014; 160: 695– 703.
    Article Locations:
  15. De Berardis G, Lucisano Thou, D'Ettorre A, Pellegrini F, Lepore V, Tognoni One thousand, et al. Clan of aspirin use with major bleeding in patients with and without diabetes. JAMA 2012; 307: 2286– 94.
    Article Locations:
  16. Clasp: a randomised trial of low-dose aspirin for the prevention and treatment of pre-eclampsia amid 9364 significant women. CLASP (Collaborative Low-dose Aspirin Study in Pregnancy) Collaborative Group. Lancet 1994; 343: 619– 29.
    Commodity Locations:
  17. Ahrens KA, Silverish RM, Mumford SL, Sjaarda LA, Perkins NJ, Wactawski-Wende J, et al. Complications and safety of preconception low-dose aspirin among women with prior pregnancy losses. Obstet Gynecol 2016; 127: 689– 98.
    Article Locations:
  18. Slone D, Siskind V, Heinonen OP, Monson RR, Kaufman DW, Shapiro South. Aspirin and congenital malformations. Lancet 1976; one: 1373– five.
    Article Locations:
  19. Werler MM, Mitchell AA, Shapiro S. Starting time trimester maternal medication use in relation to gastroschisis. Teratology 1992; 45: 361– 7.
    Article Locations:
  20. Werler MM, Sheehan JE, Mitchell AA. Maternal medication utilize and risks of gastroschisis and small-scale intestinal atresia. Am J Epidemiol 2002; 155: 26– 31.
    Article Locations:
  21. Martinez-Frias ML, Rodriguez-Pinilla Due east, Prieto 50. Prenatal exposure to salicylates and gastroschisis: a case-control study. Teratology 1997; 56: 241– 3.
    Article Locations:
  22. Kozer Due east, Nikfar S, Costei A, Boskovic R, Nulman I, Koren M. Aspirin consumption during the first trimester of pregnancy and congenital anomalies: a meta-analysis. Am J Obstet Gynecol 2002; 187: 1623– 30.
    Commodity Locations:
  23. Sibai BM, Mirro R, Chesney CM, Leffler C. Depression-dose aspirin in pregnancy. Obstet Gynecol 1989; 74: 551– 7.
    Commodity Locations:
  24. Wyatt-Ashmead J. Antenatal closure of the ductus arteriosus and hydrops fetalis. Pediatr Dev Pathol 2011; 14: 469– 74.
    Article Locations:
  25. Levin DL, Mills LJ, Parkey Thou, Garriott J, Campbell W. Constriction of the fetal ductus arteriosus later on assistants of indomethacin to the pregnant Ewe. J Pediatr 1979; 94: 647– fifty.
    Article Locations:
  26. Coomarasamy A, Honest H, Papaioannou S, Gee H, Khan KS. Aspirin for prevention of preeclampsia in women with historical risk factors: a systematic review. Obstet Gynecol 2003; 101: 1319– 32.
    Commodity Locations:
  27. Elsevier. Clinical pharmacology . Available at: http://www.clinicalpharmacology.com/. Retrieved March 20, 2018.
    Commodity Locations:
  28. Roberge S, Nicolaides KH, Demers S, Villa P, Bujold Eastward. Prevention of perinatal expiry and adverse perinatal result using depression-dose aspirin: a meta-assay. Ultrasound Obstet Gynecol 2013; 41: 491– 9.
    Article Locations:
  29. Bujold E, Roberge South, Lacasse Y, Agency M, Audibert F, Marcoux S, et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol 2010; 116: 402– 14.
    Article Locations:
  30. Roberge S, Bujold E, Nicolaides KH. Aspirin for the prevention of preterm and term preeclampsia: systematic review and metaanalysis. Am J Obstet Gynecol 2017; 218: 287– 93.e1.
    Article Locations:
  31. Roberge S, Nicolaides K, Demers Southward, Hyett J, Chaillet North, Bujold E. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol 2017; 216: 110– xx.e6.
    Commodity Locations:
  32. Meher S, Duley L, Hunter K, Askie L. Antiplatelet therapy before or subsequently xvi weeks' gestation for preventing preeclampsia: an individual participant data meta-analysis. Am J Obstet Gynecol 2017; 216: 121– eight.e2.
    Article Locations:
  33. Caritis S, Sibai B, Hauth J, Lindheimer Dr., Klebanoff M, Thom E, et al. Low-dose aspirin to forestall preeclampsia in women at loftier take a chance. National Institute of Child Wellness and Human Development Network of Maternal–Fetal Medicine Units. N Engl J Med 1998; 338: 701– 5.
    Article Locations:
  34. Sibai BM, Caritis SN, Thom East, Klebanoff Thou, McNellis D, Rocco Fifty, et al. Prevention of preeclampsia with low-dose aspirin in healthy, nulliparous pregnant women. The National Establish of Kid Wellness and Human Development Network of Maternal–Fetal Medicine Units. N Engl J Med 1993; 329: 1213– 8.
    Article Locations:
  35. Schisterman EF, Silver RM, Lesher LL, Faraggi D, Wactawski-Wende J, Townsend JM, et al. Preconception low-dose aspirin and pregnancy outcomes: results from the EAGeR randomised trial. Lancet 2014; 384: 29– 36.
    Article Locations:
  36. Narouze S, Benzon HT, Provenzano DA, Buvanendran A, De Andres J, Deer TR, et al. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American Order of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Guild, the Northward American Neuromodulation Social club, and the World Institute of Pain. Reg Anesth Pain Med 2015; xl: 182– 212.
    Commodity Locations:
  37. Wallenburg HC, Dekker GA, Makovitz JW, Rotmans P. Low-dose aspirin prevents pregnancy-induced hypertension and pre-eclampsia in angiotensin-sensitive primigravidae. Lancet 1986; 1: one– 3.
    Article Locations:
  38. Low-dose aspirin in prevention and handling of intrauterine growth retardation and pregnancy-induced hypertension. Italian study of aspirin in pregnancy. Lancet 1993; 341: 396– 400.
    Article Locations:
  39. Rolnik DL, Wright D, Poon LC, O'Gorman N, Syngelaki A, de Paco Matallana C, et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med 2017; 377: 613– 22.
    Commodity Locations:
  40. Rai R, Backos M, Baxter Northward, Chilcott I, Regan 50. Recurrent miscarriage—an aspirin a day? Hum Reprod 2000; 15: 2220– 3.
    Article Locations:
  41. Frias AEJr, Luikenaar RA, Sullivan AE, Lee RM, Porter TF, Branch DW, et al. Poor obstetric outcome in subsequent pregnancies in women with prior fetal death. Obstet Gynecol 2004; 104: 521– vi.
    Commodity Locations:
  42. Salafia CM, Minior VK, Pezzullo JC, Popek EJ, Rosenkrantz TS, Vintzileos AM. Intrauterine growth restriction in infants of less than thirty-ii weeks' gestation: associated placental pathologic features. Am J Obstet Gynecol 1995; 173: 1049– 57.
    Article Locations:
  43. Roberge S, Giguere Y, Villa P, Nicolaides K, Vainio K, Forest JC, et al. Early administration of low-dose aspirin for the prevention of severe and mild preeclampsia: a systematic review and meta-analysis [published erratum appears in Am J Perinatol 2014;31:e3]. Am J Perinatol 2012; 29: 551– 6.
    Article Locations:
  44. Roberge S, Villa P, Nicolaides Grand, Giguere Y, Vainio K, Bakthi A, et al. Early on assistants of depression-dose aspirin for the prevention of preterm and term preeclampsia: a systematic review and meta-analysis. Fetal Diagn Ther 2012; 31: 141– 6.
    Article Locations:
  45. Wallenburg HC, Rotmans N. Prevention of recurrent idiopathic fetal growth retardation by depression-dose aspirin and dipyridamole. Am J Obstet Gynecol 1987; 157: 1230– five.
    Article Locations:
  46. Leitich H, Egarter C, Husslein P, Kaider A, Schemper Thou. A meta-assay of low dose aspirin for the prevention of intrauterine growth retardation. Br J Obstet Gynaecol 1997; 104: 450– 9.
    Article Locations:
  47. Abramovici A, Cantu J, Jenkins SM. Tocolytic therapy for acute preterm labor. Obstet Gynecol Clin North Am 2012; 39: 77– 87.
    Article Locations:
  48. van Vliet EO, Askie LA, Mol BW, Oudijk MA. Antiplatelet agents and the prevention of spontaneous preterm birth: a systematic review and meta-analysis. Obstet Gynecol 2017; 129: 327– 36.
    Commodity Locations:
  49. Silver RM, Ahrens Chiliad, Wong LF, Perkins NJ, Galai Due north, Lesher LL, et al. Low-dose aspirin and preterm birth: a randomized controlled trial. Obstet Gynecol 2015; 125: 876– 84.
    Article Locations:
  50. Empson 1000, Lassere M, Craig JC, Scott JR. Recurrent pregnancy loss with antiphospholipid antibody: a systematic review of therapeutic trials. Obstet Gynecol 2002; 99: 135– 44.
    Commodity Locations:
  51. de Jong PG, Kaandorp South, Di Nisio K, Goddijn M, Middeldorp S. Aspirin and/or heparin for women with unexplained recurrent miscarriage with or without inherited thrombophilia. Cochrane Database of Systematic Reviews 2014, Consequence seven. Art. No.: CD004734.
    Article Locations:

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Published online on June 25, 2018.

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Low-dose aspirin utilise during pregnancy. ACOG Committee Opinion No. 743. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;132:e44–52.

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Source: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/07/low-dose-aspirin-use-during-pregnancy

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