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CC BY 4.0 · Thromb Haemost
DOI: 10.1055/a-2755-2565
Original Article: Stroke, Systemic or Venous Thromboembolism

Identifying Thromboprophylaxis and Aspirin Use in Pregnancy: Predictors and Maternal Outcomes—the Italian MoMs Study

Authors

  • Elvira Grandone 

    1   Obstetrics and Gynaecology Department, University of Foggia, Foggia, Italy
    2   Thrombosis and Haemostasis Unit, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni R., Foggia, Italy
    3   Department of Obstetrics, Gynaecology and Perinatal Medicine, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia

  • Mario Mastroianno

    2   Thrombosis and Haemostasis Unit, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni R., Foggia, Italy

  • Felice Sorrentino

    1   Obstetrics and Gynaecology Department, University of Foggia, Foggia, Italy

  • Gabriella Cicerone

    1   Obstetrics and Gynaecology Department, University of Foggia, Foggia, Italy

  • Donatella Colaizzo

    2   Thrombosis and Haemostasis Unit, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni R., Foggia, Italy

  • Leonardo Latino

    2   Thrombosis and Haemostasis Unit, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni R., Foggia, Italy

  • Lorenzo Lo Muzio

    1   Obstetrics and Gynaecology Department, University of Foggia, Foggia, Italy

  • Stefano Bettocchi

    1   Obstetrics and Gynaecology Department, University of Foggia, Foggia, Italy

  • Lucia Mirabella

    4   Scientific Direction, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni R., Foggia, Italy

  • Angelo Ostuni

    5   Department of Surgical and Medical Science, Anesthesia and Intensive Care, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy

  • Antonio de Laurenzo

    2   Thrombosis and Haemostasis Unit, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni R., Foggia, Italy

  • Francesca Gorgoglione

    6   Immunohematology and Transfusion Medicine Service, Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy

  • Tiziana Palladino

    7   Department of Obstetrics and Gynecology University of Bari, Bari, Italy
    8   Anesthesia and Intensive Care, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Foggia, Italy

  • Pasquale Vaira

    7   Department of Obstetrics and Gynecology University of Bari, Bari, Italy

  • Antonella Vimercati

    6   Immunohematology and Transfusion Medicine Service, Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy

  • Ettore Cicinelli

    6   Immunohematology and Transfusion Medicine Service, Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy

  • Behnood Bikdeli

    8   Anesthesia and Intensive Care, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Foggia, Italy
    9   Division of Cardiovascular Medicine and Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

  • Eleni Kaldoudi

    10   YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States

  • Luigi Nappi

    1   Obstetrics and Gynaecology Department, University of Foggia, Foggia, Italy

  • Gregory Piazza

    8   Anesthesia and Intensive Care, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Foggia, Italy

  • Maurizio Margaglione

    11   Medical Physics and Medical Informatics, Democritus University of Thrace, Komotini, Greece

Funding Information This research was in part funded by Italian Ministry of Health, RC2021. It is also partially funded by the European Union under the Horizon Europe Innovation Action ThrombUS+ (Grant Agreement No. 101137227). The views and opinions expressed are solely those of the authors and do not necessarily represent those of the European Union or HADEA, the granting authority. Neither the European Union nor HADEA can be held responsible for these views.
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Graphical Abstract

Abstract

Background

The use of low-molecular-weight heparin (LMWH) and aspirin during pregnancy is increasing, yet robust clinical trial evidence supporting their efficacy remains limited.

Patients and Methods

In a multicenter prospectively enrolled cohort study, we evaluated the prescription patterns and associated maternal–fetal outcomes of antithrombotic therapy in 2,622 women admitted for delivery across three Italian obstetric centers between January 2022 and November 2023. Data were collected on conception methods, administration details (timing, dose, indication) of LMWH and low-dose aspirin (LDA), and maternal–fetal outcomes from admission to postpartum discharge. Data on prescription of antithrombotic drugs were available for 1,898 women.

Results

Among 1,898 women with available data, 157 (8.3%) received LDA (100 mg/day) and 746 (39.3%) received LMWH (49 during pregnancy and 697 in the postpartum period). Predictors of LMWH use included prior cesarean (OR 3.1, 95% CI 1.7–5.8), preterm delivery (OR 3.8, 95% CI 1.7–8.9), pregnancy loss (OR 2.7, 95% CI 1.5–4.9), and assisted conception (OR 14.6, 95% CI 2.8–76.5). LDA use was associated with pregnancy loss (OR 2.1, 95% CI 1.4–3.0), ART (OR 4.7, 95% CI 2.2–10.2), and LMWH co-administration (OR 2.5, 95% CI 1.1–5.5). Postpartum LMWH use was primarily associated with cesarean delivery. Postpartum hemorrhage occurred in 2.4% of cases, with no significant difference in those receiving LDA or LMWH.

Conclusion

These findings reflect current real-world prescribing practices and highlight key maternal characteristics influencing antithrombotic therapy decisions. The study underscores the importance of evidence-based approaches in the use of LMWH and LDA during pregnancy, particularly in high-risk populations, to improve maternal–fetal outcomes while minimizing unnecessary exposure to therapies with uncertain benefit.

Keywords

pregnancy - heparin - aspirin

Data Availability Statement

The data that support the findings are available on request from the corresponding author (E.G.).


Supplementary Material



Publication History

Received: 16 July 2025

Accepted after revision: 24 November 2025

Accepted Manuscript online:
26 November 2025

Article published online:
10 December 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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