Home  ›  Should I Take a Baby Aspirin Every Other Day

Should I Take a Baby Aspirin Every Other Day

Written By Saturday, March 12, 2022 Add Comment Edit

A Practice Informational has been issued for this document.

View the Do Informational

Committee on Obstetric Practice

Social club for Maternal–Fetal Medicine:

This Committee Opinion was developed by the Committee on Obstetric Exercise in collaboration with commission member T. Flint Porter, Physician, and the Gild for Maternal–Fetal Medicine in collaboration with members Cynthia Gyamfi-Bannerman, MD, MS, and Tracy Manuck, Doctor.

ABSTRACT: Low-dose aspirin has been used during pregnancy, most commonly to prevent or delay the onset of preeclampsia. The American Higher of Obstetricians and Gynecologists issued the Hypertension in Pregnancy Task Force Report recommending daily low-dose aspirin beginning in the late outset 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 one 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 condom and is associated with a low likelihood of serious maternal, or fetal complications, or both, related to use. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine support the U.S. Preventive Services Task Force guideline criteria for prevention of preeclampsia. Low-dose aspirin (81 mg/day) prophylaxis is recommended in women at high take chances of preeclampsia and should be initiated between 12 weeks and 28 weeks of gestation (optimally before 16 weeks) and continued daily until delivery. Low-dose aspirin prophylaxis should be considered for women with more than than one of several moderate gamble factors for preeclampsia. Women at adventure of preeclampsia are defined based on the presence of 1 or more high-risk factors (history of preeclampsia, multifetal gestation, renal disease, autoimmune affliction, type 1 or type 2 diabetes, and chronic hypertension) or more than 1 of several moderate-risk factors (offset pregnancy, maternal age of 35 years or older, a body mass alphabetize greater than 30, family history of preeclampsia, sociodemographic characteristics, and personal history factors). In the absence of high risk factors for preeclampsia, current prove does not support the utilise of prophylactic depression-dose aspirin for the prevention of early pregnancy loss, fetal growth restriction, stillbirth, or preterm birth.

Recommendations

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

  • Low-dose aspirin (81 mg/twenty-four hours) prophylaxis is recommended in women at loftier risk of preeclampsia and should be initiated betwixt 12 weeks and 28 weeks of gestation (optimally before 16 weeks) and continued daily until delivery.

  • Low-dose aspirin prophylaxis should exist considered for women with more than i of several moderate risk factors for preeclampsia.

  • Depression-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 restriction, in the absence of risk factors for preeclampsia.

  • Low-dose aspirin prophylaxis is non 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 pregnancy loss.

Introduction

Aspirin is a cyclooxygenase inhibitor with antiinflammatory and antiplatelet properties. Low-dose aspirin has been used during pregnancy most ordinarily to forestall or delay the onset of preeclampsia. Other suggested indications for low-dose aspirin have included prevention of stillbirth, fetal growth restriction, preterm birth, and early pregnancy loss. Recent systematic reviews of depression-dose aspirin use during pregnancy accept improved our understanding of the role of low-dose aspirin in each of these clinical situations. Despite this, the utilize of low-dose aspirin in clinical obstetrics practice remains varied. The purpose of this document is to summarize the evidence and provide current recommendations regarding the apply of low-dose aspirin in pregnancy. It should be noted that although systematic reviews and consensus statements take used unlike doses of low-dose aspirin, this document volition consider only the low-dose aspirin available in the United states of america (81 mg).

Background

In Nov 2013, ACOG issued the Hypertension in Pregnancy Task Forcefulness Report recommending daily low-dose aspirin beginning in the belatedly commencement trimester for women with a history of early-onset preeclampsia and preterm commitment at less than 34 0/vii weeks of gestation, or for women with more than than one prior pregnancy complicated by preeclampsia 1. The post-obit year, the U.S. Preventive Services Job Forcefulness (USPSTF) published a similar guideline, although the listing of indications for low-dose aspirin use was more than expansive Tabular array 1 2. The USPSTF guideline also suggested that low-dose aspirin be considered in women with "several" moderate take chances factors for preeclampsia Table i.

Low-Dose Aspirin Use During Pregnancy

Other health care organizations besides have published guidelines for preeclampsia prevention using low-dose aspirin based on gamble factors. Published in 2011, the World Wellness Arrangement guideline recommended that low-dose aspirin (75 mg/solar day) be initiated before 20 weeks of gestation for women at high run a risk of preeclampsia; eg, women with a history of preeclampsia, diabetes, chronic hypertension, renal illness, autoimmune disease, and multiple gestations 3. The National Constitute of Wellness and Intendance Excellence published a quality statement, Antenatal Cess of Pre-eclampsia Risk, in July 2013 that asked health intendance providers to prescribe low-dose aspirin (75 mg/day) to significant women at increased risk of preeclampsia at the first prenatal visit, to be taken daily from 12 weeks of gestation until birth 4. The degree of chance of preeclampsia was based on the presence of i or more than high-risk factors (hypertensive disease in previous pregnancy, chronic kidney disease autoimmune disease, type one or type two diabetes, and chronic hypertension) or more one moderate-risk factor (kickoff pregnancy, maternal age of 40 years or older, a body mass index greater than 35, family unit 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-one and COX-ii), which are necessary for prostaglandin biosynthesis. The COX-1 isoform is present in the vascular endothelium and regulates the production of prostacyclin and thromboxane A ii, prostaglandins with opposing regulatory furnishings on vascular homeostasis and platelet function. Prostacyclin is a stiff vasodilator and inhibitor of platelet aggregation, whereas thromboxane A two (TXA2) is a strong vasoconstrictor and promotes platelet aggregation. The COX-2 isoform is inducible and expressed about exclusively following exposure to cytokines or other inflammatory mediators. The effect of aspirin on COX-dependent prostaglandin synthesis is dose dependent. At lower dosages (threescore–150 mg/twenty-four hour period) aspirin irreversibly acetylates COX-1, resulting in decreased platelet synthesis of TXA2 without affecting vascular wall production of prostacyclin 5 6. At higher doses, aspirin inhibits both COX-1 and COX-2, effectively blocking all prostaglandin product.

Prove suggesting that an imbalance in prostacyclin and TXA2 metabolism was involved in the development of preeclampsia prompted the initial studies of aspirin for preeclampsia prevention because of its preferential inhibition of TXA2 at lower doses 7 8. Withal, it is likely that preeclampsia is a result of poor placentation from a variety of causes, including ischemia, reperfusion, or dysfunctional maternal inflammatory response towards the trophoblast 1 9. Whether low-dose aspirin improves early on placental perfusion is unknown, and too, the precise mechanism by which low-dose aspirin prevents preeclampsia in some women is besides uncertain 10 xi.

Risks of Aspirin Use in Pregnancy

Maternal Risks

The majority of systematic reviews of randomized controlled trials (RCTs) have found no increase in hemorrhagic complications associated with low-dose aspirin during pregnancy 12 13 xiv. A USPSTF report on depression-dose aspirin for prevention of preeclampsia identified no increased risk of placental abruption (11 trials [23,332 women]; relative hazard [RR], ane.17; CI, 0.93–1.48), postpartum hemorrhage (nine trials [22,760 participants]; RR, 1.02; CI, 0.96–1.09), or hateful blood loss (five trials, [2,478 women]; RR not reported) 14. Long-term daily aspirin use in non-meaning adults (less than 300 mg/day for more than 5 years) has been associated with an increased risk of major gastrointestinal and cerebral bleeding episodes 15. 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 3.2%) 16.

Fetal Risks

Several systematic reviews of trials using depression-dose aspirin for prevention of preeclampsia take shown no increased risk of congenital anomalies 12 13 fourteen. Moreover, a recent RCT of 1,228 women, 615 of whom received depression-dose aspirin start before pregnancy and continuing throughout pregnancy, found no increased risk of adverse fetal or neonatal effects associated with low-dose aspirin exposure 17. The number of congenital malformations also was not found to be increased among a accomplice of almost 15,000 women who reported aspirin employ during the commencement trimester eighteen. Withal, business organisation has been raised most a possible clan between aspirin use during pregnancy and gastroschisis 19 20 21. A meta-analysis that included five example–control studies suggested that a history of aspirin use was twice as common in women with infants with gastroschisis compared with matched controls without gastroschisis 22. All the same, these data should be interpreted with farthermost caution. In this meta-assay, the dose of aspirin was not indicated (thus information technology is non clear whether this applies to the use of low-dose aspirin), the written report evaluated women using aspirin in the first trimester but and is subject to retrieve bias, and in that location were a number of variables not controlled, including use of other licit and illicit drugs in these trials.

The use of low-dose aspirin (threescore–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. All the same, 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 than 30,000 women treated in RCTs involving the study of low-dose aspirin versus placebo for effect on a variety of outcomes 12 14 26.

The most contempo Cochrane meta-analysis did not notice an increased chance of neonatal intracranial hemorrhage (x trials [26,184 infants]) or other neonatal hemorrhagic complications (eight trials [27,032 infants]) associated with maternal ingestion of depression-dose aspirin during the third trimester 12. Analysis of pooled data in the USPSTF systematic review was likewise reassuring, with no increase in intracerebral hemorrhage associated with low-dose aspirin use during pregnancy (10 RCTs [22,158 women]; RR, 0.84; CI, 0.61–1.sixteen) 14.

Contraindications to Aspirin Utilise During Pregnancy

At that place are few accented contraindications to aspirin therapy 27. Patients with a history of aspirin allergy (eg, urticaria) or hypersensitivity to other salicylates are at take chances of anaphylaxis and should non receive low-dose aspirin. Because of pregnant cross-sensitivity between 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 issue in life-threatening bronchoconstriction and should be avoided. The same is true in patients with asthma who have a history of aspirin-induced acute bronchospasm 27. Relative contraindications to low-dose aspirin include a history of gastrointestinal bleeding, agile peptic ulcer affliction, other sources of gastrointestinal or genitourinary bleeding, and severe hepatic dysfunction. Reye syndrome has been reported rarely (less than one%) 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 run a risk factors for obstetric bleeding should be considered on a case-by-example footing.

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 handling between 12 weeks and 28 weeks of gestation. Some investigators accept reported optimal results but when treatment is started before xvi weeks 28 29 thirty 31. A contempo meta-analysis of aggregate data from 45 randomized trials reported only a modest reduction in preeclampsia when low-dose aspirin was started later on 16 weeks (RR, 0.81; CI, 0.66–0.99) simply significant reductions in astringent preeclampsia (RR, 0.47; CI, 0.26–0.83) and fetal growth restriction (RR, 0.56; CI, 0.44–0.70) were demonstrated when low-dose aspirin was started before xvi weeks 31. In some other meta-assay, which included data from the recent Combined Multimarker Screening and Randomized Patient Handling with Aspirin for Evidence-Based Preeclampsia Prevention trial, the authors reported a reduction in preterm preeclampsia only in the subgroup of patients in which aspirin was initiated earlier 16 weeks of gestation at a daily dose of 100 mg or more (RR, 0.33; 95% CI, 0.nineteen–0.57) thirty. In dissimilarity, another report pooled individual data from 31 high-quality randomized trials and institute that the beneficial effects of depression-dose aspirin were consistent, whether treatment was started before or subsequently 16 weeks of gestation 32.

There is no credible benefit to stopping low-dose aspirin earlier delivery. Study protocols specific to pregnancy take varied, with some discontinuing low-dose aspirin at 36 weeks of gestation and others continuing low-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 non a contraindication to neuraxial blockade 36. Some patients present to care in the showtime trimester on low-dose aspirin. Whether first-trimester exposure is associated with adverse fetal effects or maternal do good 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 small trials suggested that low-dose aspirin may be beneficial for women at loftier risk of preeclampsia 37 eight. However, until recently, this finding was non confirmed in larger RCTs xvi 33 38, including a multicenter trial sponsored past the Eunice Kennedy Shriver National Plant of Child Health and Human Evolution, which included more than 5,000 women 33. The 2017 Aspirin for Evidence-Based Preeclampsia Prevention trial randomized 1,776 women at high risk of preeclampsia based on a showtime-trimester screening algorithm to 150-mg aspirin or placebo 39. The authors found a significant decrease in the rate of preterm preeclampsia (iv.3% versus 1.6%; 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 comparison 60–eighty mg versus 150 mg. Further, the screening algorithm used includes get-go-trimester serum markers, including placental growth gene and pregnancy-associated plasma protein-A, as well as uterine artery dopplers, which limits the generalizability to a U.South. population. Therefore, a higher dose or doubling of the available 81-mg dose cannot be recommended at this time.

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

The 2014 USPSTF guideline on depression-dose aspirin for prevention of morbidity and mortality from preeclampsia is based on the findings of their systematic review, which pooled data from xv high-quality RCTs, 13 of which reported preeclampsia incidence among women considered at highest risk of affliction Tabular array i 2. A 24% reduction in preeclampsia (RR, 0.76; CI, 0.62–0.95) with depression-dose aspirin prophylaxis (60–150 mg/day) was demonstrated 14. Even so, the authors suggested this dramatic reduction in relative risk might be closer to 10% because of "small study furnishings" of most of the included trials. Depending on baseline preeclampsia gamble, the relative risk reduction with depression-dose aspirin was associated with a pocket-sized decrease in an absolute risk reduction of 2–5%.

Based on the findings from the USPSTF and others, low-dose aspirin prophylaxis (81 mg/day) after 12 weeks of gestation modestly reduces the risk of preeclampsia in women at increased risk, without resulting in agin fetal effects, increased maternal haemorrhage, or placental abruption. The recommendation to give low-dose aspirin prophylaxis to high-risk women is based on the number needed to care for in individual risk groups, which in turn is based on disease prevalence and handling effect. In depression-gamble groups (disease prevalence of 2%), the number needed to treat is approximately 500, compared with a number needed to treat of 50 women in a high-take a chance group with a disease prevalence of twenty%. The USPSTF guideline recommends giving low-dose aspirin after 12 weeks of gestation to women with an accented risk of preeclampsia of at least 8%, the lowest incidence of preeclampsia in command groups of studies included in their review ii. Based on historic and demographic hazard factors, the USPSTF guideline recommends that women with whatever of the high-hazard factors for preeclampsia should receive low-dose aspirin prophylaxis. Low-dose aspirin prophylaxis should be considered in women with more than than 1 of several moderate risk factors for preeclampsia Table 1.

The American College of Obstetricians and Gynecologists and the Club 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 high take a chance of preeclampsia and should be initiated between 12 weeks and 28 weeks of gestation (optimally before 16 weeks) and connected daily until commitment. Women who were receiving medically-indicated depression-dose aspirin for other established medical indications before 12–28 weeks may continue with low-dose aspirin treatment.

Insufficient Evidence for Low-Dose Aspirin

Stillbirth

Low-dose aspirin prophylaxis is non recommended for women with a history of stillbirth in the absenteeism of gamble factors for preeclampsia. Stillbirth and preeclampsia share many of the same risk factors, and when stillbirth is related to placental dysfunction, the underlying mechanisms are also likely like. Few studies have focused solely on the event of low-dose aspirin prophylaxis on stillbirth. In one early on nonrandomized trial, investigators reported a nearly twofold increment in live births when low-dose aspirin was given to women with at least one prior pregnancy loss at more than than 13 weeks of gestation and a negative result on antiphospholipid antibody testing xl. Findings were similar in a retrospective cohort written report of 230 women with prior fetal loss at more than 10 weeks of gestation 41. However, the results of prospectively collected stillbirth data from RCTs and meta-analyses designed to study the apply of low-dose aspirin for preeclampsia prevention are inconclusive 12 13 14. Until additional supportive bear witness becomes available, depression-dose aspirin prophylaxis is non recommended solely for the indication of prior unexplained stillbirth in the absence of take chances factors for preeclampsia.

Fetal Growth Restriction

Low-dose aspirin prophylaxis for prevention of recurrent fetal growth brake is similarly not currently recommended in women without other risk factors for preeclampsia because of bereft evidence in women with an isolated history of fetal growth restriction. Withal, in women at risk of preeclampsia, prophylaxis with depression-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 nigh common pathology associated with fetal growth restriction 42. Some investigators have suggested that low-dose aspirin, initiated early in the first trimester, may prevent fetal growth brake through its inhibitory action on platelet aggregation and improvement in placental development 43 44. One study get-go reported that low-dose aspirin, in combination with dipyridamole, significantly reduced the incidence of recurrent fetal growth brake 45. Although this outcome was confirmed in a subsequent meta-analysis, the written report did not identify which women were most probable to do good from depression-dose aspirin 46. There are currently no well-powered RCTs evaluating the role of depression-dose aspirin in the prevention of recurrent fetal growth brake in otherwise low-adventure women. Systematic reviews of low-dose aspirin when used in the setting of preeclampsia prevention have consistently reported a 10–xx% reduction in fetal growth restriction or infants who were minor for gestational historic period 12 13 fourteen 29 thirty 31 32. Evidence as to whether starting depression-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 take suggested improved benefit with earlier initiation 29 30 31 32. Currently, considering 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 gamble of preeclampsia—non with histories of fetal growth restriction alone—at that place is insufficient evidence to support the apply of low-dose aspirin for fetal growth restriction prophylaxis in the absenteeism of other hazard factors for preeclampsia.

Preterm Nativity

The upshot of low-dose aspirin on preterm birth equally a primary outcome remains understudied. Even so, until evidence from loftier-quality studies directed towards prevention of spontaneous preterm birth get available, low-dose aspirin prophylaxis for prevention of spontaneous preterm birth, in the absence of take a chance factors for preeclampsia, is non recommended.

Aspirin has been shown to decrease uterine contractility past inhibiting COX-dependent prostaglandin synthesis 47. Loftier doses of aspirin take been studied to care for preterm labor, but the irreversible bounden to COX-2 and adverse maternal and fetal effects of high-dose aspirin prohibit its use in the clinical setting. Low-dose aspirin has been reported to reduce preterm nascence (at less than 37 weeks of gestation) in 8–xiv% of women at risk of preeclampsia 12 13 14 32. 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 (28,797 participants) that supplied sufficient item regarding whether delivery was spontaneous or medically indicated. In that study, treatment with low-dose aspirin resulted in a 7% reduction in the run a risk of spontaneous preterm birth at fewer than 37 weeks (RR, 0.93; 95% CI, 0.86–0.996) and a fourteen% reduction in spontaneous preterm birth at fewer than 34 weeks (RR, 0.86; 95% CI, 0.76–0.99) compared with controls. Spontaneous preterm nativity at fewer than 28 weeks was reduced past 19%, only the difference was non statistically significant (RR, 0.81; 95% CI, 0.59–i.ane) 48. Another study using information 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, 0.72; 95% CI, 0.42–ane.23), spontaneous preterm nascency (RR, 0.51; 95% CI, 0.xix–1.34), or medically indicated preterm birth (RR, 0.89; 95% CI, 0.44–1.fourscore) 49.

Indications for Which There Is No Benefit for Low-Dose Aspirin

Early Pregnancy Loss

The combination of depression-dose aspirin and unfractionated or depression-molecular-weight heparin has been shown to reduce the risk of early pregnancy loss in women with antiphospholipid syndrome fifty. All the same, 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 (256 participants), one written report reported no increase in live births among women treated with depression-dose aspirin compared with placebo (RR: 0.94, CI, 0.80–1.11) 51. A 2014 report also reported no deviation in live births when 1,078 women with one or 2 prior pregnancy losses were given low-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 bachelor evidence, the employ of depression-dose aspirin prophylaxis is not recommended for the prevention of early pregnancy loss.

Conclusions

Daily low-dose aspirin utilize in pregnancy is considered safe and is associated with a depression likelihood of serious maternal, or fetal complications, or both, related to use. The American College of Obstetricians and Gynecologists and the Social club 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 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 divers based on the presence of one or more than loftier-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-take chances cistron (first pregnancy, maternal historic period of 35 years or older, a torso mass index greater than 30, family unit history of preeclampsia, sociodemographic characteristics, and personal history factors) Table ane. In the absence of loftier-risk factors for preeclampsia, current evidence does not support the employ of prophylactic low-dose aspirin for the prevention of early pregnancy loss, fetal growth restriction, stillbirth, or preterm birth.

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/Task-Strength-and-Piece of work-Group-Reports/Hypertension-in-Pregnancy. Retrieved January 24, 2018.
    Article Locations:
  2. LeFevre ML. Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: U.S. Preventive Services Task Force recommendation argument. U.S. Preventive Services Task Force. Ann Intern Med 2014; 161: 819– 26.
    Commodity Locations:
  3. World Health Arrangement. WHO recommendations for prevention and handling of pre-eclampsia and eclampsia . Geneva (Switzerland): WHO; 2011. Available at: http://apps.who.int/iris/bitstream/10665/44703/ane/9789241548335_eng.pdf. Retrieved January 24, 2018.
    Article Locations:
  4. National Institute for Health and Care Excellence. Hypertension in pregnancy: quality standard . Manchester (United Kingdom): NICE; 2013. Bachelor at: https://world wide web.nice.org.great britain/guidance/qs35/resources/hypertension-in-pregnancy-2098607923141. Retrieved Jan 26, 2018.
    Commodity Locations:
  5. Clarke RJ, Mayo G, Price P, FitzGerald GA. Suppression of thromboxane A2 simply not of systemic prostacyclin past controlled-release aspirin. Due north 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.
    Commodity Locations:
  7. Benigni A, Gregorini G, Frusca T, Chiabrando C, Ballerini S, Valcamonico A, et al. Effect of low-dose aspirin on fetal and maternal generation of thromboxane by platelets in women at gamble for pregnancy-induced hypertension. N Engl J Med 1989; 321: 357– 62.
    Article Locations:
  8. Schiff E, Peleg E, Goldenberg M, Rosenthal T, Ruppin E, Tamarkin One thousand, et al. The use of aspirin to prevent pregnancy-induced hypertension and lower the ratio of thromboxane A2 to prostacyclin in relatively high hazard pregnancies. N Engl J Med 1989; 321: 351– half-dozen.
    Article Locations:
  9. Sibai B, Dekker K, Kupferminc One thousand. Pre-eclampsia. Lancet 2005; 365: 785– 99.
    Article Locations:
  10. Coomarasamy A, Papaioannou S, Gee H, Khan KS. Aspirin for the prevention of preeclampsia in women with aberrant uterine artery Doppler: a meta-analysis. Obstet Gynecol 2001; 98: 861– 6.
    Commodity Locations:
  11. Scazzocchio Due east, Oros D, Diaz D, Ramirez JC, Ricart One thousand, Meler E, et al. Bear on of aspirin on trophoblastic invasion in women with abnormal uterine artery Doppler at eleven–14 weeks: a randomized controlled study. Ultrasound Obstet Gynecol 2017; 49: 435– 41.
    Article Locations:
  12. Duley L, Henderson-Smart DJ, Meher Due south, King JF. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database of Systematic Reviews 2007, Event 2. Fine art. No.: CD004659.
    Article Locations:
  13. Askie LM, Duley L, Henderson-Smart DJ, Stewart LA. Antiplatelet agents for prevention of pre-eclampsia: a meta-assay of individual patient data. PARIS Collaborative Group. Lancet 2007; 369: 1791– 8.
    Commodity Locations:
  14. Henderson JT, Whitlock EP, O'Connor E, Senger CA, Thompson JH, Rowland MG. Depression-dose aspirin for prevention of morbidity and mortality from preeclampsia: a systematic evidence review for the U.S. Preventive Services Task Strength. Ann Intern Med 2014; 160: 695– 703.
    Commodity Locations:
  15. De Berardis G, Lucisano One thousand, D'Ettorre A, Pellegrini F, Lepore V, Tognoni G, 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 handling of pre-eclampsia among 9364 pregnant women. Squeeze (Collaborative Low-dose Aspirin Study in Pregnancy) Collaborative Group. Lancet 1994; 343: 619– 29.
    Commodity Locations:
  17. Ahrens KA, Silver RM, Mumford SL, Sjaarda LA, Perkins NJ, Wactawski-Wende J, et al. Complications and prophylactic 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 S. Aspirin and congenital malformations. Lancet 1976; 1: 1373– v.
    Article Locations:
  19. Werler MM, Mitchell AA, Shapiro South. First trimester maternal medication utilise in relation to gastroschisis. Teratology 1992; 45: 361– 7.
    Article Locations:
  20. Werler MM, Sheehan JE, Mitchell AA. Maternal medication use and risks of gastroschisis and modest intestinal atresia. Am J Epidemiol 2002; 155: 26– 31.
    Article Locations:
  21. Martinez-Frias ML, Rodriguez-Pinilla E, Prieto 50. Prenatal exposure to salicylates and gastroschisis: a case-control written report. Teratology 1997; 56: 241– 3.
    Article Locations:
  22. Kozer Due east, Nikfar South, Costei A, Boskovic R, Nulman I, Koren K. Aspirin consumption during the first trimester of pregnancy and congenital anomalies: a meta-analysis. Am J Obstet Gynecol 2002; 187: 1623– 30.
    Article Locations:
  23. Sibai BM, Mirro R, Chesney CM, Leffler C. Low-dose aspirin in pregnancy. Obstet Gynecol 1989; 74: 551– vii.
    Article Locations:
  24. Wyatt-Ashmead J. Antenatal closure of the ductus arteriosus and hydrops fetalis. Pediatr Dev Pathol 2011; fourteen: 469– 74.
    Article Locations:
  25. Levin DL, Mills LJ, Parkey M, Garriott J, Campbell West. Constriction of the fetal ductus arteriosus afterward assistants of indomethacin to the pregnant Ewe. J Pediatr 1979; 94: 647– 50.
    Commodity Locations:
  26. Coomarasamy A, Honest H, Papaioannou S, Gee H, Khan KS. Aspirin for prevention of preeclampsia in women with historical chance factors: a systematic review. Obstet Gynecol 2003; 101: 1319– 32.
    Commodity Locations:
  27. Elsevier. Clinical pharmacology . Available at: http://world wide web.clinicalpharmacology.com/. Retrieved March 20, 2018.
    Article Locations:
  28. Roberge S, Nicolaides KH, Demers S, Villa P, Bujold E. Prevention of perinatal death and agin perinatal effect using low-dose aspirin: a meta-analysis. Ultrasound Obstet Gynecol 2013; 41: 491– 9.
    Article Locations:
  29. Bujold E, Roberge Due south, Lacasse Y, Bureau M, Audibert F, Marcoux S, et al. Prevention of preeclampsia and intrauterine growth brake 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.
    Commodity Locations:
  31. Roberge S, Nicolaides 1000, Demers S, Hyett J, Chaillet Due north, Bujold E. The function 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.
    Article Locations:
  32. Meher Southward, Duley 50, Hunter K, Askie L. Antiplatelet therapy before or subsequently 16 weeks' gestation for preventing preeclampsia: an private participant data meta-analysis. Am J Obstet Gynecol 2017; 216: 121– viii.e2.
    Article Locations:
  33. Caritis S, Sibai B, Hauth J, Lindheimer Physician, Klebanoff Thousand, Thom Eastward, et al. Low-dose aspirin to prevent preeclampsia in women at high hazard. National Found of Kid Health and Homo Development Network of Maternal–Fetal Medicine Units. North Engl J Med 1998; 338: 701– 5.
    Article Locations:
  34. Sibai BM, Caritis SN, Thom E, Klebanoff M, McNellis D, Rocco L, et al. Prevention of preeclampsia with low-dose aspirin in healthy, nulliparous pregnant women. The National Institute of Child Health and Man Development Network of Maternal–Fetal Medicine Units. N Engl J Med 1993; 329: 1213– viii.
    Article Locations:
  35. Schisterman EF, Silver RM, Lesher LL, Faraggi D, Wactawski-Wende J, Townsend JM, et al. Preconception depression-dose aspirin and pregnancy outcomes: results from the EAGeR randomised trial. Lancet 2014; 384: 29– 36.
    Commodity Locations:
  36. Narouze S, Benzon HT, Provenzano DA, Buvanendran A, De Andres J, Deer TR, et al. Interventional spine and hurting procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American Guild of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Hurting Therapy, the American Academy of Pain Medicine, the International Neuromodulation Club, the Due north American Neuromodulation Society, and the Globe Plant of Pain. Reg Anesth Pain Med 2015; 40: 182– 212.
    Article 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; one: 1– 3.
    Article Locations:
  38. Low-dose aspirin in prevention and handling of intrauterine growth retardation and pregnancy-induced hypertension. Italian report 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 gamble for preterm preeclampsia. Northward Engl J Med 2017; 377: 613– 22.
    Article Locations:
  40. Rai R, Backos M, Baxter N, Chilcott I, Regan Fifty. 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 result in subsequent pregnancies in women with prior fetal death. Obstet Gynecol 2004; 104: 521– 6.
    Article Locations:
  42. Salafia CM, Minior VK, Pezzullo JC, Popek EJ, Rosenkrantz TS, Vintzileos AM. Intrauterine growth brake in infants of less than thirty-two weeks' gestation: associated placental pathologic features. Am J Obstet Gynecol 1995; 173: 1049– 57.
    Article Locations:
  43. Roberge Due south, Giguere Y, Villa P, Nicolaides K, Vainio G, Woods 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– vi.
    Commodity Locations:
  44. Roberge S, Villa P, Nicolaides G, Giguere Y, Vainio M, Bakthi A, et al. Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: a systematic review and meta-analysis. Fetal Diagn Ther 2012; 31: 141– vi.
    Article Locations:
  45. Wallenburg HC, Rotmans Due north. Prevention of recurrent idiopathic fetal growth retardation by low-dose aspirin and dipyridamole. Am J Obstet Gynecol 1987; 157: 1230– 5.
    Commodity Locations:
  46. Leitich H, Egarter C, Husslein P, Kaider A, Schemper M. A meta-analysis of depression 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 Northward 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.
    Article Locations:
  49. Silvery RM, Ahrens K, Wong LF, Perkins NJ, Galai North, Lesher LL, et al. Depression-dose aspirin and preterm birth: a randomized controlled trial. Obstet Gynecol 2015; 125: 876– 84.
    Article Locations:
  50. Empson M, Lassere Grand, Craig JC, Scott JR. Recurrent pregnancy loss with antiphospholipid antibody: a systematic review of therapeutic trials. Obstet Gynecol 2002; 99: 135– 44.
    Article Locations:
  51. de Jong PG, Kaandorp S, Di Nisio M, Goddijn K, Middeldorp South. Aspirin and/or heparin for women with unexplained recurrent miscarriage with or without inherited thrombophilia. Cochrane Database of Systematic Reviews 2014, Effect seven. Fine art. No.: CD004734.
    Article Locations:

This information is designed equally an educational resource to aid clinicians in providing obstetric and gynecologic care, and apply of this information is voluntary. This data should not exist considered as inclusive of all proper treatments or methods of care or as a argument of the standard of intendance. It is not intended to substitute for the contained professional judgment of the treating clinician. Variations in practice may exist warranted when, in the reasonable judgment of the treating clinician, such form of action is indicated past the condition of the patient, limitations of bachelor resource, or advances in knowledge or technology. The American College of Obstetricians and Gynecologists reviews its publications regularly; notwithstanding, its publications may not reflect the nigh recent evidence. Any updates to this document can exist found on world wide web.acog.org or by calling the ACOG Resource Heart.

While ACOG makes every endeavour to present accurate and reliable information, this publication is provided "as is" without whatever warranty of accurateness, reliability, or otherwise, either express or implied. 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 volition 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.

All ACOG committee members and authors accept submitted a conflict of involvement disclosure statement related to this published production. Whatever potential conflicts have been considered and managed in accordance with ACOG's Disharmonize of Interest Disclosure Policy. The ACOG policies can be establish on acog.org. For products jointly developed with other organizations, conflict of interest disclosures by representatives of the other organizations are addressed by those organizations. The American Higher of Obstetricians and Gynecologists has neither solicited nor accepted any commercial interest in the development of the content of this published product.

Published online on June 25, 2018.

Copyright 2018 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any course or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

Requests for authority to make photocopies should be directed to Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400.

American College of Obstetricians and Gynecologists 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920

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

barreradirly1980.blogspot.com

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

0 Response to "Should I Take a Baby Aspirin Every Other Day"

Post a Comment

Subscribe to: Post Comments (Atom)

Iklan Atas Artikel

Iklan Tengah Artikel 1

Iklan Tengah Artikel 2

Iklan Bawah Artikel