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What's the Purpose of Taking Baby Aspirin and Calcium in Pregnancy

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Commission on Obstetric Do

Society for Maternal–Fetal Medicine:

This Committee Opinion was adult by the Committee on Obstetric Practice in collaboration with committee member T. Flint Porter, Dr., and the Society for Maternal–Fetal Medicine in collaboration with members Cynthia Gyamfi-Bannerman, Md, MS, and Tracy Manuck, Dr..

ABSTRACT: Low-dose aspirin has been used during pregnancy, most unremarkably to forbid or delay the onset of preeclampsia. The American College of Obstetricians and Gynecologists issued the Hypertension in Pregnancy Task Force Report recommending daily low-dose aspirin beginning in the late beginning trimester for women with a history of early-onset preeclampsia and preterm commitment 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 listing of indications for depression-dose aspirin use was more expansive. Daily low-dose aspirin use in pregnancy is considered safety and is associated with a depression likelihood of serious maternal, or fetal complications, or both, related to employ. 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 risk of preeclampsia and should exist initiated betwixt 12 weeks and 28 weeks of gestation (optimally before 16 weeks) and connected daily until delivery. Low-dose aspirin prophylaxis should be considered for women with more one of several moderate risk factors for preeclampsia. Women at adventure of preeclampsia are defined based on the presence of ane or more than high-adventure factors (history of preeclampsia, multifetal gestation, renal affliction, autoimmune affliction, type 1 or type two diabetes, and chronic hypertension) or more than than 1 of several moderate-risk factors (first pregnancy, maternal historic period of 35 years or older, a torso mass index greater than xxx, family history of preeclampsia, sociodemographic characteristics, and personal history factors). In the absenteeism of high hazard factors for preeclampsia, current evidence does non support the utilise of prophylactic low-dose aspirin for the prevention of early pregnancy loss, fetal growth restriction, stillbirth, or preterm nativity.

Recommendations

The American Higher of Obstetricians and Gynecologists (ACOG) and the Social club for Maternal–Fetal Medicine brand the post-obit recommendations:

  • Low-dose aspirin (81 mg/24-hour interval) prophylaxis is recommended in women at high take chances of preeclampsia and should be initiated betwixt 12 weeks and 28 weeks of gestation (optimally earlier 16 weeks) and connected daily until delivery.

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

  • Low-dose aspirin prophylaxis is not recommended solely for the indication of prior unexplained stillbirth, in the absence of run a risk factors for preeclampsia.

  • Low-dose aspirin prophylaxis is not recommended for prevention of fetal growth restriction, in the absenteeism of take chances factors for preeclampsia.

  • Low-dose aspirin prophylaxis is non recommended for the prevention of spontaneous preterm nascency, in the absence of risk factors for preeclampsia.

  • Low-dose aspirin prophylaxis is not recommended for the prevention of early pregnancy loss.

Introduction

Aspirin is a cyclooxygenase inhibitor with antiinflammatory and antiplatelet properties. Depression-dose aspirin has been used during pregnancy most commonly to prevent 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. Contempo systematic reviews of low-dose aspirin apply during pregnancy have improved our understanding of the role of depression-dose aspirin in each of these clinical situations. Despite this, the utilize of low-dose aspirin in clinical obstetrics practise remains varied. The purpose of this document is to summarize the testify and provide current recommendations regarding the use of depression-dose aspirin in pregnancy. It should be noted that although systematic reviews and consensus statements take used different doses of low-dose aspirin, this document volition consider just the low-dose aspirin available in the United States (81 mg).

Background

In Nov 2013, ACOG issued the Hypertension in Pregnancy Task Force Report recommending daily low-dose aspirin beginning in the late first 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 than than i prior pregnancy complicated by preeclampsia i. The following yr, the U.Southward. Preventive Services Job Force (USPSTF) published a similar guideline, although the list of indications for low-dose aspirin use was more expansive Table 1 2. The USPSTF guideline too suggested that low-dose aspirin be considered in women with "several" moderate adventure factors for preeclampsia Table i.

Low-Dose Aspirin Use During Pregnancy

Other health intendance organizations also have published guidelines for preeclampsia prevention using low-dose aspirin based on take chances factors. Published in 2011, the Globe Wellness Arrangement guideline recommended that low-dose aspirin (75 mg/day) be initiated before 20 weeks of gestation for women at high risk of preeclampsia; eg, women with a history of preeclampsia, diabetes, chronic hypertension, renal affliction, autoimmune disease, and multiple gestations 3. The National Establish of Health and Intendance Excellence published a quality statement, Antenatal Assessment of Pre-eclampsia Risk, in July 2013 that asked health care providers to prescribe low-dose aspirin (75 mg/day) to pregnant women at increased chance of preeclampsia at the first prenatal visit, to be taken daily from 12 weeks of gestation until nascence iv. The degree of risk of preeclampsia was based on the presence of i or more high-take a chance factors (hypertensive illness in previous pregnancy, chronic kidney affliction autoimmune affliction, type 1 or blazon 2 diabetes, and chronic hypertension) or more than 1 moderate-risk factor (first pregnancy, maternal age of 40 years or older, a body mass index greater than 35, family history of preeclampsia, and multiple pregnancy) 4.

Pathophysiology

Aspirin (acetylsalicylic acrid) is a nonsteroidal antiinflammatory drug (NSAID) that works primarily through its inhibition of two cyclooxygenase isoenzymes (COX-1 and COX-ii), which are necessary for prostaglandin biosynthesis. The COX-1 isoform is present in the vascular endothelium and regulates the product of prostacyclin and thromboxane A ii, prostaglandins with opposing regulatory furnishings on vascular homeostasis and platelet part. Prostacyclin is a potent vasodilator and inhibitor of platelet assemblage, whereas thromboxane A 2 (TXA2) is a potent vasoconstrictor and promotes platelet assemblage. The COX-2 isoform is inducible and expressed near exclusively post-obit exposure to cytokines or other inflammatory mediators. The effect of aspirin on COX-dependent prostaglandin synthesis is dose dependent. At lower dosages (lx–150 mg/day) aspirin irreversibly acetylates COX-one, resulting in decreased platelet synthesis of TXA2 without affecting vascular wall production of prostacyclin 5 6. At college doses, aspirin inhibits both COX-1 and COX-ii, effectively blocking all prostaglandin production.

Evidence 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 considering of its preferential inhibition of TXA2 at lower doses vii viii. However, it is likely that preeclampsia is a event of poor placentation from a diversity of causes, including ischemia, reperfusion, or dysfunctional maternal inflammatory response towards the trophoblast one nine. Whether low-dose aspirin improves early placental perfusion is unknown, and likewise, the precise mechanism by which low-dose aspirin prevents preeclampsia in some women is also uncertain 10 11.

Risks of Aspirin Use in Pregnancy

Maternal Risks

The majority of systematic reviews of randomized controlled trials (RCTs) have institute no increase in hemorrhagic complications associated with low-dose aspirin during pregnancy 12 13 fourteen. A USPSTF study on depression-dose aspirin for prevention of preeclampsia identified no increased risk of placental abruption (11 trials [23,332 women]; relative risk [RR], ane.17; CI, 0.93–1.48), postpartum hemorrhage (nine trials [22,760 participants]; RR, one.02; CI, 0.96–ane.09), or mean blood loss (5 trials, [2,478 women]; RR not reported) 14. Long-term daily aspirin use in non-pregnant adults (less than 300 mg/24-hour interval for more 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 hazard was slightly greater in treated patients, (4.0% versus three.2%) xvi.

Fetal Risks

Several systematic reviews of trials using low-dose aspirin for prevention of preeclampsia have shown no increased chance of built anomalies 12 xiii fourteen. Moreover, a recent RCT of one,228 women, 615 of whom received low-dose aspirin beginning before pregnancy and standing throughout pregnancy, found no increased take a chance of agin fetal or neonatal effects associated with low-dose aspirin exposure 17. The number of built malformations as well was not establish to be increased amidst a cohort of nigh 15,000 women who reported aspirin use during the commencement trimester 18. All the same, business organisation has been raised nearly a possible clan between aspirin use during pregnancy and gastroschisis xix 20 21. A meta-analysis that included five instance–control studies suggested that a history of aspirin utilize was twice as common in women with infants with gastroschisis compared with matched controls without gastroschisis 22. Withal, these information should be interpreted with farthermost circumspection. In this meta-analysis, the dose of aspirin was not indicated (thus it is non clear whether this applies to the employ of low-dose aspirin), the study evaluated women using aspirin in the get-go trimester only and is bailiwick to recall bias, and at that place were a number of variables not controlled, including utilise of other licit and illicit drugs in these trials.

The use of low-dose aspirin (60–150 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. However, in dissimilarity to this and other studies that did not differentiate type of dose of NSAID exposure, no increment in perinatal deaths from persistent pulmonary hypertension in the neonate has been reported amidst more than xxx,000 women treated in RCTs involving the study of low-dose aspirin versus placebo for result on a diverseness of outcomes 12 14 26.

The well-nigh recent Cochrane meta-assay did not detect an increased risk of neonatal intracranial hemorrhage (10 trials [26,184 infants]) or other neonatal hemorrhagic complications (eight trials [27,032 infants]) associated with maternal ingestion of depression-dose aspirin during the tertiary trimester 12. Analysis of pooled data in the USPSTF systematic review was besides reassuring, with no increment in intracerebral hemorrhage associated with depression-dose aspirin employ during pregnancy (10 RCTs [22,158 women]; RR, 0.84; CI, 0.61–one.16) xiv.

Contraindications to Aspirin Use During Pregnancy

There are few accented contraindications to aspirin therapy 27. Patients with a history of aspirin allergy (eg, urticaria) or hypersensitivity to other salicylates are at run a risk of anaphylaxis and should not receive depression-dose aspirin. Considering of significant cross-sensitivity between aspirin and other nonsteroidal drugs, depression-dose aspirin is as well contraindicated in patients with known hypersensitivity to NSAIDs. Exposure to low-dose aspirin in patients with nasal polyps may result in life-threatening bronchoconstriction and should be avoided. The same is true in patients with asthma who have a history of aspirin-induced astute bronchospasm 27. Relative contraindications to low-dose aspirin include a history of gastrointestinal bleeding, active peptic ulcer disease, other sources of gastrointestinal or genitourinary haemorrhage, and astringent hepatic dysfunction. Reye syndrome has been reported rarely (less than 1%) in children younger than 18 years who are given aspirin while recovering from viral illnesses, particularly influenza and chickenpox. The decision to proceed low-dose aspirin in the presence of obstetric haemorrhage or hazard factors for obstetric bleeding should be considered on a case-by-case basis.

Timing of Use During Pregnancy

With the exception of studies of depression-dose aspirin for prevention of early on pregnancy loss, the majority of trials using depression-dose aspirin during pregnancy have initiated handling between 12 weeks and 28 weeks of gestation. Some investigators accept reported optimal results only when treatment is started earlier sixteen weeks 28 29 30 31. A contempo meta-assay of aggregate data from 45 randomized trials reported only a modest reduction in preeclampsia when low-dose aspirin was started subsequently 16 weeks (RR, 0.81; CI, 0.66–0.99) only significant reductions in severe preeclampsia (RR, 0.47; CI, 0.26–0.83) and fetal growth brake (RR, 0.56; CI, 0.44–0.lxx) were demonstrated when low-dose aspirin was started earlier xvi weeks 31. In another meta-analysis, which included data from the recent Combined Multimarker Screening and Randomized Patient Treatment 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 before 16 weeks of gestation at a daily dose of 100 mg or more (RR, 0.33; 95% CI, 0.19–0.57) 30. In dissimilarity, another report pooled individual data from 31 high-quality randomized trials and found that the beneficial effects of low-dose aspirin were consistent, whether handling was started earlier or subsequently 16 weeks of gestation 32.

There is no credible benefit to stopping low-dose aspirin before delivery. Study protocols specific to pregnancy have varied, with some discontinuing low-dose aspirin at 36 weeks of gestation and others continuing low-dose aspirin until commitment 14 33 34 35. Discontinuation timing has non been related to excessive maternal or fetal haemorrhage. Likewise, low-dose aspirin use in the absence of other anticoagulants is not a contraindication to neuraxial blockade 36. Some patients present to care in the starting time trimester on depression-dose aspirin. Whether commencement-trimester exposure is associated with adverse fetal furnishings or maternal benefit is not known.

Indications for Low-Dose Aspirin During Pregnancy

Prevention of Preeclampsia

The hypothesis that preeclampsia might exist 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 benign for women at high hazard of preeclampsia 37 eight. Yet, until recently, this finding was not confirmed in larger RCTs xvi 33 38, including a multicenter trial sponsored by the Eunice Kennedy Shriver National Institute of Kid Wellness and Human Development, which included more 5,000 women 33. The 2017 Aspirin for Show-Based Preeclampsia Prevention trial randomized one,776 women at high risk of preeclampsia based on a beginning-trimester screening algorithm to 150-mg aspirin or placebo 39. The authors plant a significant subtract in the charge per unit of preterm preeclampsia (4.3% versus 1.vi%; odds ratio, 0.38; 95% CI, 0.20–0.74). Although the 150-mg dose was used in this study, at that place are no bachelor studies comparing threescore–80 mg versus 150 mg. Further, the screening algorithm used includes showtime-trimester serum markers, including placental growth factor and pregnancy-associated plasma poly peptide-A, likewise every bit uterine artery dopplers, which limits the generalizability to a U.Due south. population. Therefore, a college dose or doubling of the available 81-mg dose cannot be recommended at this time.

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

The 2014 USPSTF guideline on depression-dose aspirin for prevention of morbidity and bloodshed from preeclampsia is based on the findings of their systematic review, which pooled information from fifteen high-quality RCTs, 13 of which reported preeclampsia incidence among women considered at highest risk of illness Table one 2. A 24% reduction in preeclampsia (RR, 0.76; CI, 0.62–0.95) with low-dose aspirin prophylaxis (60–150 mg/24-hour interval) was demonstrated 14. However, the authors suggested this dramatic reduction in relative take a chance might be closer to 10% because of "pocket-size study effects" of almost of the included trials. Depending on baseline preeclampsia risk, the relative risk reduction with low-dose aspirin was associated with a small decrease in an absolute run a risk reduction of two–5%.

Based on the findings from the USPSTF and others, depression-dose aspirin prophylaxis (81 mg/solar day) subsequently 12 weeks of gestation modestly reduces the take chances of preeclampsia in women at increased risk, without resulting in agin fetal effects, increased maternal bleeding, or placental abruption. The recommendation to give low-dose aspirin prophylaxis to loftier-take a chance women is based on the number needed to treat in private risk groups, which in plough is based on disease prevalence and treatment consequence. In depression-take chances groups (affliction prevalence of ii%), the number needed to treat is approximately 500, compared with a number needed to treat of fifty women in a high-adventure group with a affliction prevalence of 20%. The USPSTF guideline recommends giving low-dose aspirin after 12 weeks of gestation to women with an accented risk of preeclampsia of at least viii%, the lowest incidence of preeclampsia in control groups of studies included in their review two. Based on historic and demographic risk factors, the USPSTF guideline recommends that women with any of the high-risk factors for preeclampsia should receive depression-dose aspirin prophylaxis. Low-dose aspirin prophylaxis should be considered in women with more than 1 of several moderate risk factors for preeclampsia Table 1.

The American Higher of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine support the USPSTF guideline criteria for prevention of preeclampsia. Low-dose aspirin (81 mg/mean solar day) prophylaxis is recommended in women at high risk of preeclampsia and should be initiated between 12 weeks and 28 weeks of gestation (optimally earlier 16 weeks) and continued daily until delivery. Women who were receiving medically-indicated depression-dose aspirin for other established medical indications before 12–28 weeks may go on with low-dose aspirin handling.

Insufficient Evidence for Low-Dose Aspirin

Stillbirth

Low-dose aspirin prophylaxis is not recommended for women with a history of stillbirth in the absenteeism of run a risk 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 as well likely like. Few studies accept focused solely on the issue of low-dose aspirin prophylaxis on stillbirth. In one early on nonrandomized trial, investigators reported a nearly twofold increase in live births when low-dose aspirin was given to women with at least one prior pregnancy loss at more than xiii weeks of gestation and a negative outcome on antiphospholipid antibiotic testing 40. Findings were similar in a retrospective accomplice study of 230 women with prior fetal loss at more than 10 weeks of gestation 41. Notwithstanding, the results of prospectively collected stillbirth data from RCTs and meta-analyses designed to report the use of depression-dose aspirin for preeclampsia prevention are inconclusive 12 thirteen 14. Until additional supportive bear witness becomes available, low-dose aspirin prophylaxis is not recommended solely for the indication of prior unexplained stillbirth in the absence of risk factors for preeclampsia.

Fetal Growth Restriction

Low-dose aspirin prophylaxis for prevention of recurrent fetal growth restriction is similarly not currently recommended in women without other hazard factors for preeclampsia because of insufficient evidence in women with an isolated history of fetal growth restriction. However, in women at gamble of preeclampsia, prophylaxis with low-dose aspirin (particularly when initiated less than 16 weeks of gestation) may reduce the take a chance of fetal growth brake. Aberrant placentation resulting in poor placental perfusion (ie, placental insufficiency) is the most common pathology associated with fetal growth restriction 42. Some investigators accept suggested that low-dose aspirin, initiated early in the first trimester, may foreclose fetal growth restriction through its inhibitory action on platelet assemblage and improvement in placental development 43 44. Ane study showtime reported that depression-dose aspirin, in combination with dipyridamole, significantly reduced the incidence of recurrent fetal growth restriction 45. Although this outcome was confirmed in a subsequent meta-analysis, the study did non identify which women were well-nigh probable to benefit from low-dose aspirin 46. There are currently no well-powered RCTs evaluating the function of low-dose aspirin in the prevention of recurrent fetal growth brake in otherwise low-risk women. Systematic reviews of low-dose aspirin when used in the setting of preeclampsia prevention take consistently reported a 10–20% reduction in fetal growth brake or infants who were small for gestational age 12 thirteen xiv 29 30 31 32. Evidence as to whether starting low-dose aspirin before xvi weeks of gestation influences the caste 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 testify supporting a reduction of fetal growth brake from low-dose aspirin prophylaxis comes from studies of women who were also at risk of preeclampsia—non with histories of fetal growth restriction alone—in that location is bereft evidence to support the utilize of depression-dose aspirin for fetal growth restriction prophylaxis in the absence of other chance factors for preeclampsia.

Preterm Nativity

The effect of depression-dose aspirin on preterm birth equally a primary consequence remains understudied. However, until bear witness from high-quality studies directed towards prevention of spontaneous preterm birth become available, low-dose aspirin prophylaxis for prevention of spontaneous preterm birth, in the absenteeism of hazard factors for preeclampsia, is not recommended.

Aspirin has been shown to decrease uterine contractility by inhibiting COX-dependent prostaglandin synthesis 47. High doses of aspirin have been studied to treat preterm labor, just the irreversible bounden to COX-2 and adverse maternal and fetal effects of high-dose aspirin prohibit its use in the clinical setting. Depression-dose aspirin has been reported to reduce preterm birth (at less than 37 weeks of gestation) in viii–fourteen% 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 about 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 detail regarding whether delivery was spontaneous or medically indicated. In that written report, treatment with depression-dose aspirin resulted in a vii% reduction in the 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 nascency at fewer than 28 weeks was reduced by 19%, simply the divergence was not statistically significant (RR, 0.81; 95% CI, 0.59–1.1) 48. Some other 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 earlier pregnancy and connected through pregnancy, was not associated with a reduction in overall preterm births (RR, 0.72; 95% CI, 0.42–i.23), spontaneous preterm nascency (RR, 0.51; 95% CI, 0.19–one.34), or medically indicated preterm birth (RR, 0.89; 95% CI, 0.44–1.80) 49.

Indications for Which There Is No Do good for Depression-Dose Aspirin

Early Pregnancy Loss

The combination of low-dose aspirin and unfractionated or low-molecular-weight heparin has been shown to reduce the adventure of early on pregnancy loss in women with antiphospholipid syndrome 50. However, low-dose aspirin has not been shown to prevent unexplained early pregnancy loss in women who do non accept antiphospholipid syndrome. Pooling data from two trials (256 participants), one report reported no increase in live births amidst women treated with low-dose aspirin compared with placebo (RR: 0.94, CI, 0.lxxx–1.11) 51. A 2014 study also reported no deviation in live births when 1,078 women with one or 2 prior pregnancy losses were given depression-dose aspirin or placebo before pregnancy (58% versus 53%, P=.0984). Pregnancy loss occurred in 13% of 535 women given depression-dose aspirin compared with 12% of 543 women in the placebo group ( P=.7812) 35. Based on the available evidence, the use of depression-dose aspirin prophylaxis is non recommended for the prevention of early pregnancy loss.

Conclusions

Daily low-dose aspirin use in pregnancy is considered rubber 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 Society 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 high risk of preeclampsia and should be initiated between 12 weeks and 28 weeks of gestation (optimally before xvi weeks) and connected daily until delivery. 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 defined based on the presence of one or more high-hazard factors (history of preeclampsia, multifetal gestation, renal illness, autoimmune illness, type i or type ii diabetes, and chronic hypertension) or more than i moderate-take chances factor (first pregnancy, maternal age of 35 years or older, a body mass index greater than 30, family history of preeclampsia, sociodemographic characteristics, and personal history factors) Table 1. In the absence of high-risk factors for preeclampsia, electric current bear witness does not back up the use of prophylactic low-dose aspirin for the prevention of early pregnancy loss, fetal growth restriction, stillbirth, or preterm birth.

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Published online on June 25, 2018.

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

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

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