Effect of low dose aspirin on fetal outcome in women at risk for developing pregnancy induced hypertension

Authors

  • Madhusmita Pradhan Department of Obstetrics and Gynecology, SCB Medical College and Hospital, Cuttack, Odisha, India
  • Jyotiranjan Champatiray Department of Pediatrics, SVPPGIP, SCB Medical College and Hospital, Cuttack, Odisha, India
  • Kishore V. S. Department of Pediatrics, SCB Medical College and Hospital, Cuttack, Odisha, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20201145

Keywords:

Aspirin, Fetus, LBW, Pre-eclampsia

Abstract

Background: Though pregnancy induced hypertension is a worldwide problem, it is more prevalent in developing countries particularly south east Asian and African countries. It contributes to 20% of perinatal death and 40-50% of low birth weight babies in India. Fetal salvage is also an important consideration in providing quality care. Low dose aspirin given between 12 weeks to 28 weeks of gestational age in high-risk women at Developing Pregnancy Induced Hypertension (PIH) is anticipated to prevent the development of PIH and complications that arises especially those regarding maternal and fetal mortality due to PIH.

Methods: This prospective randomized controlled trial was conducted in the dept of O and G, SCB MC and Hospital, Cuttack during November 2018 to October 2019. Pregnant women between the gestational age of 13 to 28 week were screened for risk factors and included in this study. Low dose aspirin of 60 mg daily till delivery was given to pregnant women who consented to be a part of study randomly with the other group taking placebo.

Results: Incidence of IUGR babies in low dose aspirin treated mothers was as low as 1%. Incidence of LBW babies is lower in low dose aspirin treated mothers than with those who were not treated. Mean birth weight in cases was 2780 gm±352 gm vs control 2592 gm±483 gm. There is increased incidence of still birth in high risk group not treated with aspirin. No significant difference in reducing incidence premature deliveries between case and control.

Conclusions: Low dose aspirin has a definite role in the prevention of PIH in high risk pregnancy and its complication like IUGR and low birth weight. Low dose aspirin reduces the incidence of PIH. Low dose aspirin can be considered a safe drug without any deleterious side effect for mother and the fetus. Benefits of prevention of PIH, justifies its administration in women at high risk.

References

Rolnik DL, Wright D, Poon LC, Syngelaki A, O'Gorman N, de Paco Matallana C, et al. ASPRE trial: performance of screening for preterm pre‐eclampsia. Ultrasound Obstetr Gynecol. 2017 Oct;50(4):492-5.

American College of Obstetricians and Gynecologists: Committee on Obstetric Practice, Society for Maternal–Fetal Medicine Number 73, Available at: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Low-Dose-Aspirin-Use-During-Pregnancy. Accessed 13th January 2020.

Patrono C. The multifaceted clinical readouts of platelet inhibition by low-dose aspirin. J Am Coll Cardiol. 2015 Jul 7;66(1):74-85.

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. New Eng J Med. 2017 Aug 17;377(7):613-22.

Redman CW. Hypertension in pregnancy: the NICE guidelines. Heart. 2011 Dec 1;97(23):1967-9.

Hernández-Díaz S, Toh S, Cnattingius S. Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study. BMJ. 2009 Jun 18;338:b2255.

Pritchard JA, MacDonald PC. Hypertensive disorders in pregnancy. In Williams’s obstetrics, 16th ed. Appleton and Lange; 1990:665-700.

Wallenburg HC, Rotmans N. Prevention of recurrent idiopathic fetal growth retardation by low-dose aspirin and dipyridamole. Am J Obstetr Gynecol. 1987 Nov 1;157(5):1230-5.

CLASP: A randomised trial of low-dose aspirin for the prevention and treatment of pre-eclampsia among 9364 pregnant women. CLASP (Collaborative Low-dose Aspirin Study in Pregnancy) Collaborative Group. Lancet. 1994;343:619-29.

Kozer E, Costei AM, Boskovic R, Nulman I, Nikfar S, Koren G. Effects of aspirin consumption during pregnancy on pregnancy outcomes: Meta‐analysis. Birth Defec Res Part B: Develop Reprod Toxicol. 2003 Feb;68(1):70-84.

Chiaffarino F, Parazzini F, Paladini D, Acaia B, Ossola W, Marozio L, et al. A small randomised trial of low-dose aspirin in women at high risk of pre-eclampsia. Eur J Obstetr Gynecol Reprod Biol. 2004 Feb 10;112(2):142-4.

Henderson JT, Whitlock EP, O’Connor E, Senger CA, Thompson JH, Rowland MG. Low-dose aspirin for prevention of morbidity and mortality from preeclampsia: a systematic evidence review for the US Preventive Services Task Force. Annal Inter Med. 2014 May 20;160(10):695-703.

Valcamonico A, Foschini M, Soregaroli M, Tarantini M, Frusca T. Low dose aspirin in pregnancy: a clinical and biochemical study of effects on the newborn. J Perinatal Med-Offici J WAPM. 1993;21(3):235-40.

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 Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med. 1993;329:1213-8.

Souza EV, Torloni MR, Atallah AN, Dos Santos GM, Kulay Jr L, Sass N. Aspirin plus calcium supplementation to prevent superimposed preeclampsia: a randomized trial. Brazil J Med Biolog Res. 2014 May;47(5):419-25.

Medically indicated late-preterm and early- term deliveries. ACOG Committee Opinion No. 764. American College of Obstetricians and Gynecologist. Obstet Gynecol. 2019;133:e151-55.

Downloads

Published

2020-03-21

Issue

Section

Original Research Articles