A prophylactic low-dose aspirin earlier than 12 weeks until delivery should be considered to prevent preeclampsia
Jing Zhu1, Rong Huang2, Jinwen Zhang3
1MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Starting low-dose aspirin earlier in pregnancy may prevent preeclampsia and fetal growth restriction. Evidence suggests it is safe and improves placental function, challenging current 12-week guidelines.
Area of Science:
- Obstetrics and Gynecology
- Reproductive Medicine
- Maternal-Fetal Medicine
Background:
- Low-dose aspirin is recommended for preeclampsia prevention after 12 weeks' gestation.
- Concerns about maternal bleeding and fetal anomalies influenced the current guideline.
- Defective placentation is a key factor in preeclampsia development.
Purpose of the Study:
- To evaluate the safety and efficacy of initiating low-dose aspirin earlier than 12 weeks' gestation.
- To assess the impact of early low-dose aspirin on placentation and uteroplacental blood flow.
- To review evidence regarding maternal and perinatal outcomes with early low-dose aspirin use.
Main Methods:
- Review of clinical trials and meta-analyses on low-dose aspirin in pregnancy.
- Analysis of evidence from reproductive medicine regarding early aspirin use.
- Examination of existing literature on aspirin's effects on vascular endothelial function and placentation.
Main Results:
- Early low-dose aspirin can balance thromboxane A2 and prostacyclin levels.
- Improved placentation and adequate uteroplacental blood flow are associated with early aspirin initiation.
- Evidence does not support increased risks of adverse maternal or perinatal outcomes.
Conclusions:
- Initiating low-dose aspirin before 12 weeks' gestation is a viable option for preeclampsia prevention.
- Early aspirin use appears safe and beneficial for improving placentation.
- Continuation of low-dose aspirin as a prophylactic until delivery is supported by current evidence.
Abstract:
Clinical trials and meta-analyses have demonstrated that low-dose aspirin can reduce the risk of preeclampsia and fetal growth restriction in high-risk pregnant women. Current obstetric guidelines recommend that the administration of low-dose aspirin to prevent preeclampsia be initiated after 12 weeks' gestation. This starting time was chosen to minimize possible risks of maternal bleeding and fetal anomalies. However, evidence from reproductive medicine, where low-dose aspirin is commonly recommended to use before and in early pregnancy, as well as existing literature, does not support these concerns. On the other hand, defective placentation resulting in a subsequent ischemic placenta is considered as the starting point of preeclampsia. Low-dose aspirin initiated in early pregnancy can balance the levels of thromboxane A2 and prostacyclin and maintain adequate uteroplacental blood flow and, therefore, improve placentation. Thus, an initiation of low-dose aspirin earlier than 12 weeks can be considered. Meanwhile, evidence shows that low-dose aspirin can improve maternal vascular endothelial function without increasing the risks of adverse maternal and perinatal outcomes. Therefore, it appears safe to use low-dose aspirin as a prophylactic until delivery.
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