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WANG Jing, SHEN Li-xia, WANG Zi-lian, et al. Important Considerations of Low-Dose Aspirin in the Prevention of Preeclampsia[J]. Journal of Sichuan University (Medical Sciences), 2023, 54(2): 450-454. DOI: 10.12182/20230360207
Citation: WANG Jing, SHEN Li-xia, WANG Zi-lian, et al. Important Considerations of Low-Dose Aspirin in the Prevention of Preeclampsia[J]. Journal of Sichuan University (Medical Sciences), 2023, 54(2): 450-454. DOI: 10.12182/20230360207

Important Considerations of Low-Dose Aspirin in the Prevention of Preeclampsia

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  • Corresponding author:

    WANG Zi-lian, E-mail: wangzil@mail.sysu.edu.cn

    Liona C. Poon, E-mail: liona.poon@cuhk.edu.hk

  • Received Date: August 28, 2022
  • Revised Date: December 22, 2022
  • Available Online: March 19, 2023
  • Published Date: March 19, 2023
  • Low-dose prophylactic aspirin is widely recommended for pregnant women for the prevention of preeclampsia (PE). Although the efficacy of aspirin in preventing PE has been evaluated in many studies, due to the differences in dosage, initiation time, and screening methods for the identification of women at high risk of PE and the lack of a uniform opinion on the medication regimen of aspirin, currently in China there is no consensus on the standardized treatment scheme of aspirin for the prevention of PE in clinical guidelines. Herein, we reviewed the current available evidence and the recommendations of clinical guidelines concerning the controversies about aspirin dosage as well as the timing of starting and stopping aspirin, so as to provide further guidance for clinical practice. Based on the existing research findings on and clinical practice of using aspirin for PE prevention, we suggested that PE risk screening should be conducted at 11-13+6 weeks of gestation. In addition, the recommended dose for prophylactic use of aspirin for pregnant women at high risk of PE is 150 mg/d, and the recommended minimum effective dose is 100 mg/d. Pregnant women at high risk of PE should start taking low-dose aspirin orally before 16 weeks of pregnancy. Week 36 of gestation is considered the window of opportunity for discontinuation of low-dose aspirin.
  • [1]
    何国琳, 刘兴会. 产科医生眼中的子痫前期. 四川大学学报(医学版),2022,53(6): 1003–1006. DOI: 10.12182/20221160203
    [2]
    DULEY L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol,2009,33(3): 130–137. DOI: 10.1053/j.semperi.2009.02.010
    [3]
    HELMO F R, LOPES A, CARNEIRO A, et al. Angiogenic and antiangiogenic factors in preeclampsia. Pathol Res Pract,2018,214(1): 7–14. DOI: 10.1016/j.prp.2017.10.021
    [4]
    HEIDA K Y, FRANX A, Van RIJN B B, et al. Earlier age of onset of chronic hypertension and type 2 diabetes mellitus after a hypertensive disorder of pregnancy or gestational diabetes mellitus. Hypertension,2015,66(6): 1116–1122. DOI: 10.1161/HYPERTENSIONAHA.115.06005
    [5]
    LYKKE J A, LANGHOFF-ROOS J, SIBAI B M, et al. Hypertensive pregnancy disorders and subsequent cardiovascular morbidity and type 2 diabetes mellitus in the mother. Hypertension,2009,53(6): 944–951. DOI: 10.1161/HYPERTENSIONAHA.109.130765
    [6]
    PINHEIRO T V, BRUNETTO S, RAMOS J G, et al. Hypertensive disorders during pregnancy and health outcomes in the offspring: a systematic review. J Dev Orig Health Dis,2016,7(4): 391–407. DOI: 10.1017/S2040174416000209
    [7]
    CARON N, RIVARD G E, MICHON N, et al. Low-dose ASA response using the PFA-100 in women with high-risk pregnancy. J Obstet Gynaecol Can,2009,31(11): 1022–1027. DOI: 10.1016/S1701-2163(16)34346-8
    [8]
    REY E, RIVARD G E. Is testing for aspirin response worthwhile in high-risk pregnancy? Eur J Obstet Gynecol Reprod Biol,2011,157(1): 38–42. DOI: 10.1016/j.ejogrb.2011.02.026
    [9]
    WYATT-ASHMEAD J. Antenatal closure of the ductus arteriosus and hydrops fetalis. Pediatr Dev Pathol,2011,14(6): 469–474. DOI: 10.2350/07-11-0368.1
    [10]
    Gestational hypertension and preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol, 2020, 135(6): e237−e260. doi: 10.1097/AOG.0000000000003891.
    [11]
    UK N G A. Hypertension in pregnancy: diagnosis and management. London: National Institute for Health and Care Excellence (UK), 2019.
    [12]
    MAGEE L A, BROWN M A, HALL D R, et al. The 2021 International Society for the study of hypertension in pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens,2022,27: 148–169. DOI: 10.1016/j.preghy.2021.09.008
    [13]
    POON L C, SHENNAN A, HYETT J A, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: a pragmatic guide for first-trimester screening and prevention. Int J Gynaecol Obstet,2019,145 Suppl 1(Suppl 1): 1–33. DOI: 10.1002/ijgo.12802
    [14]
    顾蔚蓉, 李笑天. 子痫前期的干预与管理. 中国实用妇科与产科杂志,2020,36(2): 120–123. DOI: 10.19538/j.fk2020020108
    [15]
    中华医学会妇产科学分会妊娠期高血压疾病学组. 妊娠期高血压疾病诊治指南(2020). 中华妇产科杂志,2020,55(4): 227–238. DOI: 10.3760/cma.j.cn112141-20200114-00039
    [16]
    ROLNIK D L, WRIGHT D, POON L, et al. ASPRE trial: performance of screening for preterm pre-eclampsia. Ultrasound Obstet Gynecol,2017,50(4): 492–495. DOI: 10.1002/uog.18816
    [17]
    SENTILHES L, AZRIA E, SCHMITZ T. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med,2017,377(24): 2399–2400. DOI: 10.1056/NEJMc1713798
    [18]
    ROLNIK D L, WRIGHT D, POON L C, et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med,2017,377(7): 613–622. DOI: 10.1056/NEJMoa1704559
    [19]
    DUMONT A, FLAHAULT A, BEAUFILS M, et al. Effect of aspirin in pregnant women is dependent on increase in bleeding time. Am J Obstet Gynecol,1999,180(1 Pt 1): 135–140. DOI: 10.1016/s0002-9378(99)70163-8
    [20]
    WOJTOWICZ A, UNDAS A, HURAS H, et al. Aspirin resistance may be associated with adverse pregnancy outcomes. Neuro Endocrinol Lett,2011,32(3): 334–339.
    [21]
    李冠琳, 杨慧霞. 子痫前期的发病机制及亚型分类. 中华围产医学杂志,2017,20(12): 899–903. DOI: 10.3760/cma.j.issn.1007-9408.2017.12.012
    [22]
    KUMAR N, DAS V, AGARWAL A, et al. Pilot interventional study comparing fetomaternal outcomes of 150 mg versus 75 mg aspirin starting between 11 and 14 weeks of pregnancy in patients with high risk of preeclampsia: a randomized control trial. J Obstet Gynaecol India,2020,70(1): 23–29. DOI: 10.1007/s13224-019-01277-5
    [23]
    ROBERGE S, NICOLAIDES K, DEMERS S, et al. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol,2017,216(2): 110–120. DOI: 10.1016/j.ajog.2016.09.076
    [24]
    ROBERGE S, BUJOLD E, NICOLAIDES K H. Aspirin for the prevention of preterm and term preeclampsia: systematic review and metaanalysis. Am J Obstet Gynecol,2018,218(3): 287–293. DOI: 10.1016/j.ajog.2017.11.561
    [25]
    ESPINOZA J. Low-dose aspirin for the prevention of preeclampsia. JAMA,2021,326(12): 1153–1155. DOI: 10.1001/jama.2021.14646
    [26]
    SEIDLER A L, ASKIE L, RAY J G. Optimal aspirin dosing for preeclampsia prevention. Am J Obstet Gynecol,2018,219(1): 117–118. DOI: 10.1016/j.ajog.2018.03.018
    [27]
    TAPP S, GUERBY P, GIRARD M, et al. A pilot randomized trial comparing the effects of 80 versus 160 mg of aspirin on midtrimester uterine artery pulsatility index in women with a history of preeclampsia. J Obstet Gynaecol Can,2020,42(12): 1498–1504. DOI: 10.1016/j.jogc.2020.05.013
    [28]
    HOFFMAN M K, GOUDAR S S, KODKANY B S, et al. Low-dose aspirin for the prevention of preterm delivery in nulliparous women with a singleton pregnancy (ASPIRIN): a randomised, double-blind, placebo-controlled trial. Lancet,2020,395(10220): 285–293. DOI: 10.1016/S0140-6736(19)32973-3
    [29]
    WRIGHT D, NICOLAIDES K H. Aspirin delays the development of preeclampsia. Am J Obstet Gynecol,2019,220(6): 580–581. DOI: 10.1016/j.ajog.2019.02.034
    [30]
    WRIGHT D, ROLNIK D L, SYNGELAKI A, et al. Aspirin for evidence-based preeclampsia prevention trial: effect of aspirin on length of stay in the neonatal intensive care unit. Am J Obstet Gynecol,2018,218(6): 611–612. DOI: 10.1016/j.ajog.2018.02.014
    [31]
    LEITICH H, EGARTER C, HUSSLEIN P, et al. A meta-analysis of low dose aspirin for the prevention of intrauterine growth retardation. Br J Obstet Gynaecol,1997,104(4): 450–459. DOI: 10.1111/j.1471-0528.1997.tb11497.x
    [32]
    LI X, MILOSAVLJEVIC A, ELSEA S H, et al. Effective aspirin treatment of women at risk for preeclampsia delays the metabolic clock of gestation. Hypertension,2021,78(5): 1398–1410. DOI: 10.1161/HYPERTENSIONAHA.121.17448
    [33]
    CHAEMSAITHONG P, CUENCA-GOMEZ D, PLANA M N, et al. Does low-dose aspirin initiated before 11 weeks' gestation reduce the rate of preeclampsia? Am J Obstet Gynecol,2020,222(5): 437–450. DOI: 10.1016/j.ajog.2019.08.047
    [34]
    MALLAMPATI D, GROBMAN W, ROUSE D J, et al. Strategies for prescribing aspirin to prevent preeclampsia: a cost-effectiveness analysis. Obstet Gynecol,2019,134(3): 537–544. DOI: 10.1097/AOG.0000000000003413
    [35]
    ROBERGE S, NICOLAIDES K H, DEMERS S, et al. Prevention of perinatal death and adverse perinatal outcome using low-dose aspirin: a meta-analysis. Ultrasound Obstet Gynecol,2013,41(5): 491–499. DOI: 10.1002/uog.12421
    [36]
    BELHOMME N, DOUDNIKOFF C, POLARD E, et al. Aspirin: indications and use during pregnancy. Rev Med Interne,2017,38(12): 825–832. DOI: 10.1016/j.revmed.2017.10.419
    [37]
    BUJOLD E, ROBERGE S, LACASSE Y, et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol,2010,116(2 Pt 1): 402–414. DOI: 10.1097/AOG.0b013e3181e9322a
    [38]
    CHOI Y J, SHIN S. Aspirin prophylaxis during pregnancy: a systematic review and meta-analysis. Am J Prev Med,2021,61(1): e31–e45. DOI: 10.1016/j.amepre.2021.01.032
    [39]
    ROBERGE S, GIGUERE Y, VILLA P, et al. Early administration of low-dose aspirin for the prevention of severe and mild preeclampsia: a systematic review and meta-analysis. Am J Perinatol,2012,29(7): 551–556. DOI: 10.1055/s-0032-1310527
    [40]
    ROBERGE S, VILLA P, NICOLAIDES K, 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(3): 141–146. DOI: 10.1159/000336662
    [41]
    HAAPSAMO M, MARTIKAINEN H, RASANEN J. Low-dose aspirin reduces uteroplacental vascular impedance in early and mid gestation in IVF and ICSI patients: a randomized, placebo-controlled double-blind study. Ultrasound Obstet Gynecol,2008,32(5): 687–693. DOI: 10.1002/uog.6215
    [42]
    STEEGERS E A, Von DADELSZEN P, DUVEKOT J J, et al. Pre-eclampsia. Lancet,2010,376(9741): 631–644. DOI: 10.1016/S0140-6736(10)60279-6
    [43]
    DULEY L, HENDERSON-SMART D J, MEHER S, et al. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev,2007(2): D4659. DOI: 10.1002/14651858.CD004659.pub2
    [44]
    PRADHAN M, KISHORE S V, CHAMPATIRAY J. Effect of low dose aspirin on maternal outcome in women at risk for developing pregnancy induced hypertension. Int J Reprod Contracept Obstetr Gynecol,2020,9(4): 1590–1596. DOI: 10.18203/2320-1770.ijrcog20201229
    [45]
    LIU F M, ZHAO M, WANG M, et al. Effect of regular oral intake of aspirin during pregnancy on pregnancy outcome of high-risk pregnancy-induced hypertension syndrome patients. Eur Rev Med Pharmacol Sci,2016,20(23): 5013–5016.
    [46]
    AMIN O, TASNIM N, NAEEM S. Prevention of pre-eclampsia with low dose aspirin in primigravida. MOJ Women's Health,2020,9(1): 28–32. DOI: 10.15406/mojwh.2020.09.00264
    [47]
    LEFEVRE M L. Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: U. S. Preventive Services Task Force recommendation statement. Ann Intern Med,2014,161(11): 819–826. DOI: 10.7326/M14-1884
    [48]
    TRANQUILLI A L, DEKKER G, MAGEE L, et al. The classification, diagnosis and management of the hypertensive disorders of pregnancy: a revised statement from the ISSHP. Pregnancy Hypertens,2014,4(2): 97–104. DOI: 10.1016/j.preghy.2014.02.001
    [49]
    LOWE S A, BOWYER L, LUST K, et al. The SOMANZ Guidelines for the management of hypertensive disorders of pregnancy 2014. Aust N Z J Obstet Gynaecol,2015,55(1): 11–16. DOI: 10.1111/ajo.12253
    [50]
    CARITIS S, SIBAI B, HAUTH J, et al. Low-dose aspirin to prevent preeclampsia in women at high risk. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med,1998,338(11): 701–705. DOI: 10.1056/NEJM199803123381101
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