Evaluation of Low-Dose Aspirin to Prevent Preeclampsia in Pregnant People with Chronic Hypertension

Kelli Derrah; Karen S. Greiner; Mónica Rincón; Richard M. Burwick

doi:10.1055/a-1973-7602

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2024; 41(S 01): e974-e980
DOI: 10.1055/a-1973-7602

Original Article

Evaluation of Low-Dose Aspirin to Prevent Preeclampsia in Pregnant People with Chronic Hypertension

Kelli Derrah

¹Department of Pediatrics, University of California, Davis, Sacramento, California

,

Karen S. Greiner

²Department of Obstetrics and Gynecology Kaiser Permanente San Francisco, San Francisco, California

,

Mónica Rincón

³Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon

,

Richard M. Burwick

⁴Division of Maternal-Maternal Maternal-Fetal Medicine, San Gabriel Valley Perinatal Medical Group, Pomona Valley Hospital Medical Center, Pomona, California

› Institutsangaben

Abstract

Objective Our objective was to evaluate if the use of low-dose aspirin (LDA) among pregnant individuals with chronic hypertension (CHTN) reduces the rate of superimposed preeclampsia or other adverse maternal and neonatal outcomes.

Study Design Our study included single-center cohort of pregnant individuals with CHTN who had a live birth after 23 weeks' gestation, between 2013 and 2018. The primary exposure was the use of LDA in pregnancy and the primary outcome was superimposed preeclampsia. LDA use was also evaluated by the timing of initiation, before or after 16 weeks' gestation. Secondary outcomes included preeclampsia subtypes (e.g., preeclampsia with severe features, early-onset disease), as well as adverse maternal and neonatal outcomes. Differences were analyzed by χ ², Fisher's exact, or t tests, with logistic regression to adjust for confounders.

Results Of 11,825 deliveries during the study period, 494 (4.2%) occurred in women with CHTN. Among those with CHTN, 174 (35%) were prescribed LDA, most often 81 mg daily (173 out of 174, 99%). Baseline characteristics were similar between groups, but the history of preeclampsia was more common in those prescribed LDA. The rate of superimposed preeclampsia was no different among those with CHTN-prescribed LDA compared with those who were not (36% vs. 30%, p = 0.2), even when restricting the analysis to those prescribed LDA before 16 weeks' gestation (33 vs. 30%, p = 0.2). In addition, LDA did not lead to a reduction in the rate of preeclampsia with severe features, early-onset preeclampsia, or other adverse maternal outcomes. However, the composite rate of adverse neonatal outcomes was lower in LDA users versus nonusers (4.0 vs. 13%, p = 0.002), which persisted after multivariable adjustment (adjusted odds ratio: 0.28, 95% confidence interval: 0.12–0.67).

Conclusion Among pregnant individuals with CHTN, LDA did not decrease the rate of superimposed preeclampsia. Further studies are warranted to validate our observed reduction in adverse neonatal outcomes and to determine if aspirin is more beneficial at dosages greater than 81 mg daily.

Key Points

Superimposed preeclampsia rates are the same regardless of LDA.
Decreased rate of adverse neonatal outcomes is seen with LDA.
No decrease in adverse maternal outcomes is seen with LDA.

Keywords

preeclampsia - hypertension - aspirin - neonatal - maternal - outcomes

Volltext

Referenzen

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