Related Experiment Video
Updated: Sep 16, 2025
Comprehensive Evaluation of the Effectiveness and Safety of Placenta-Targeted Drug Delivery Using Three Complementary Methods
Published on: September 10, 2018
The Nationwide Impact of Guidelines for Prophylactic Aspirin Treatment for Preeclampsia
Julie Hauer Vendelbo1, Mette Østergaard Thunbo1,2, Tine Brink Henriksen1,3
1Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Insights
National guidelines increased aspirin use for high-risk pregnancies, reducing severe preeclampsia. However, postpartum haemorrhage increased, while preterm delivery and other risks remained unchanged.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Public Health Policy
Background:
- Preeclampsia is a significant cause of maternal and neonatal mortality globally.
- Early aspirin prophylaxis is recommended for high-risk pregnancies to reduce preeclampsia incidence.
- Real-world data on aspirin's safety and efficacy outside clinical trials is limited.
Purpose of the Study:
- To evaluate the impact of Denmark's 2012 national guidelines on aspirin use for preeclampsia prevention.
- To assess the association between the guideline change and rates of preeclampsia, preterm delivery, postpartum haemorrhage (PPH), placental abruption, and neonatal intracranial haemorrhage.
Main Methods:
- Analysis of singleton pregnancies (2010-2016) from Danish national registries.
- Stratification of risk based on the 2012 Danish National Guideline for Prevention and Treatment of Preeclampsia.
- Interrupted time series analysis to compare outcomes before and after guideline implementation, with aspirin use estimated from prescription data.
Main Results:
- Aspirin use in high-risk pregnancies rose from 2.2% to 12.4% within four years post-guideline introduction.
- Severe preeclampsia incidence decreased slightly (from 6.0% to 5.2%) after the guideline change.
- Postpartum haemorrhage (PPH) rates increased in high-risk pregnancies; preterm delivery, placental abruption, and neonatal intracranial haemorrhage rates showed no significant change.
Conclusions:
- The introduction of national guidelines led to increased aspirin use for preeclampsia prophylaxis in high-risk pregnancies.
- While severe preeclampsia decreased, an increase in PPH was observed, highlighting a potential trade-off.
- The study indicates a complex relationship between aspirin prophylaxis, preeclampsia, and other maternal/neonatal outcomes, necessitating continued monitoring.
Background:
Preeclampsia is a common pregnancy complication associated with maternal and neonatal mortality. Early aspirin treatment lowers the risk of preeclampsia in high-risk pregnancies. However, knowledge of aspirin's effects and possible side effects outside clinical trials is sparse, and the evaluation of maternal and foetal safety regarding aspirin treatment is hindered by the inherent risk of confounding by indication.
Objectives:
To study if the introduction of national guidelines recommending aspirin as preeclampsia prophylaxis affects clinical practice in Denmark, measured by aspirin use and investigate if the guideline change was related to the proportion of preeclampsia, preterm delivery, postpartum haemorrhage (PPH), placental abruption or neonatal intracranial haemorrhage.
Methods:
All singleton pregnancies (1997-2016) identified in the nationwide Danish registries (gestational age ≥ 10 weeks) were included. The population was divided into persons at high or low risk of preeclampsia, according to the 2012 Danish National Guideline for Prevention and Treatment of Preeclampsia. Aspirin use was estimated based on redeemed prescriptions. The proportion of outcomes was compared using interrupted time series analyses.
Results:
Of 1,323,750 pregnant persons, 2.0% (n = 25,826) were considered at high risk of preeclampsia. After the 2012 guideline change, aspirin use in high-risk pregnancies increased from 2.2% to 12.4% in 4 years, a 0.88 (95% confidence interval [CI] 0.83, 0.93) percentage point change for every half year. Severe preeclampsia slightly decreased from 6.0% to 5.2% after the guideline change, with a -0.22 (95% CI -0.43, -0.01) percentage point change for every half year, while preterm delivery rates remained unchanged. PPH increased in high-risk pregnancies. There was no difference in the risks of placental abruption or neonatal intracranial haemorrhage.
Conclusions:
After the introduction of preventive aspirin treatment, aspirin use in high-risk pregnancies increased, and severe preeclampsia decreased. However, PPH increased, while rates of preterm delivery, placental abruption and neonatal intracranial haemorrhage remained unchanged.
More Related Videos
05:31Author Spotlight: Modeling an Aspect of Preeclampsia in Female Mice Using Hypoxic Human Placenta-Derived Small Extracellular Vesicles
Published on: January 26, 2024
14:43A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
Published on: January 12, 2018
Related Concept Videos
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:23Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
01:27Peripheral Artery Disease III: Interprofessional Care
01:29Venous Thrombosis III: Interprofessional Care
01:33Hormonal Regulation