Effect of current guidelines on prevention of pre-eclampsia with low-dose aspirin in primary settings: A
Tanja Premru-Srsen1,2, Zorana Kocic1, Ivan Verdenik3
1Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Insights
Low-dose aspirin in early pregnancy did not prevent pre-eclampsia but increased the risk of small-for-gestational-age (SGA) neonates. This indicates potential harm to fetal growth in nulliparous women with risk factors.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Public Health
Background:
- Pre-eclampsia and small-for-gestational-age (SGA) neonates are significant adverse pregnancy outcomes.
- Low-dose aspirin is often prescribed in early pregnancy for women with risk factors to prevent these complications.
- Evidence on the efficacy and safety of low-dose aspirin in diverse populations and settings requires ongoing evaluation.
Purpose of the Study:
- To assess the effectiveness of early low-dose aspirin administration in preventing pre-eclampsia.
- To determine the impact of low-dose aspirin on the incidence of small-for-gestational-age (SGA) neonates in nulliparous women.
- To evaluate the use of low-dose aspirin in primary care settings for high-risk pregnancies.
Main Methods:
- A population-based case-control study involving 47,271 nulliparous women delivering between 2013 and 2017 in Slovenia.
- Propensity score matching was employed to create a 1:1 matched sample of aspirin-treated and untreated women.
- Odds ratios (OR) with 95% confidence intervals (95% CI) were calculated to analyze the association with pre-eclampsia and SGA neonates.
Main Results:
- Low-dose aspirin treatment was associated with a significant 42.7% increase in the odds of having an SGA neonate (OR 1.427, 95% CI 1.001-2.034).
- No significant association was found between low-dose aspirin and the prevention of pre-eclampsia (OR 1.308, 95% CI 0.847-2.022).
- The study included 584 women in the treated group.
Conclusions:
- In the Slovenian population, early low-dose aspirin treatment for pre-eclampsia prevention in high-risk nulliparous women is not beneficial.
- Preventive use of low-dose aspirin in this context may adversely affect fetal growth, leading to an increased risk of SGA neonates.
- Further large-scale population-based studies are warranted to confirm these findings and inform clinical guidelines.
Objective:
To evaluate the effect of low-dose aspirin, which was administered at or before the 16th week of pregnancy due to maternal characteristics and history of a pre-existing medical condition, on prevention of pre-eclampsia, and on the birth of a small-for-gestational-age (SGA) neonate without pre-eclampsia in nulliparas in primary settings.
Methods:
We performed a case-control study using population-based data on 47 271 nulliparas with a singleton pregnancy who delivered in Slovenia from 2013 to 2017. The treated group received low-dose aspirin. For the untreated group, propensity score matching was used to perform a 1:1 matching. In the matched sample, we calculated the odds ratios (OR) with a 95% confidence interval (95% CI) with a two-way test for pre-eclampsia, as well as SGA neonates.
Results:
In the treated group (n=584), the odds for an SGA neonate were significantly increased by 42.7% (OR 1.427, 95% CI 1.001-2.034). However, we found no significant effect on the odds for pre-eclampsia (OR 1.308, 95% CI 0.847-2.022).
Conclusions:
In anticipation of more substantial population-based data studies, in the Slovenian population, preventive treatment with low-dose aspirin due to maternal characteristics and history of a pre-existing medical condition is not beneficial for the prevention of pre-eclampsia and can harm fetal growth.
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