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Pregnant and Can't Remember if I Took My Baby Aspirin

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Committee on Obstetric Practise

Society for Maternal–Fetal Medicine:

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

Abstract: Low-dose aspirin has been used during pregnancy, most commonly to prevent or delay the onset of preeclampsia. The American Higher of Obstetricians and Gynecologists issued the Hypertension in Pregnancy Chore Force Report recommending daily low-dose aspirin start in the tardily showtime trimester for women with a history of early-onset preeclampsia and preterm delivery at less than 34 0/seven weeks of gestation, or for women with more than than i prior pregnancy complicated past preeclampsia. The U.S. Preventive Services Chore Force published a similar guideline, although the list of indications for low-dose aspirin use was more than expansive. Daily low-dose aspirin apply in pregnancy is considered safe 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 Lodge for Maternal-Fetal Medicine support the U.South. Preventive Services Job Force guideline criteria for prevention of preeclampsia. Depression-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 before 16 weeks) and continued daily until delivery. Low-dose aspirin prophylaxis should be considered for women with more than 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-adventure factors (history of preeclampsia, multifetal gestation, renal illness, autoimmune affliction, blazon i or type two diabetes, and chronic hypertension) or more than than one of several moderate-take chances factors (outset 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). In the absence of high risk factors for preeclampsia, electric current testify does not back up the use of safety depression-dose aspirin for the prevention of early on pregnancy loss, fetal growth restriction, stillbirth, or preterm nascence.

Recommendations

The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal–Fetal Medicine make the following recommendations:

  • Low-dose aspirin (81 mg/solar day) prophylaxis is recommended in women at high adventure of preeclampsia and should be initiated between 12 weeks and 28 weeks of gestation (optimally before 16 weeks) and continued daily until delivery.

  • Low-dose aspirin prophylaxis should exist considered for women with more than one 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 take a chance factors for preeclampsia.

  • Low-dose aspirin prophylaxis is non recommended for prevention of fetal growth restriction, in the absence of gamble factors for preeclampsia.

  • Low-dose aspirin prophylaxis is not recommended for the prevention of spontaneous preterm birth, in the absence of risk factors for preeclampsia.

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

Introduction

Aspirin is a cyclooxygenase inhibitor with antiinflammatory and antiplatelet properties. Low-dose aspirin has been used during pregnancy most ordinarily to prevent or filibuster the onset of preeclampsia. Other suggested indications for depression-dose aspirin have included prevention of stillbirth, fetal growth restriction, preterm birth, and early pregnancy loss. Recent systematic reviews of depression-dose aspirin use during pregnancy have improved our understanding of the role of low-dose aspirin in each of these clinical situations. Despite this, the use of low-dose aspirin in clinical obstetrics practice remains varied. The purpose of this document is to summarize the evidence and provide electric current recommendations regarding the use of low-dose aspirin in pregnancy. It should be noted that although systematic reviews and consensus statements have used different doses of low-dose aspirin, this document will consider only the low-dose aspirin bachelor in the United States (81 mg).

Background

In November 2013, ACOG issued the Hypertension in Pregnancy Task Force Study recommending daily low-dose aspirin starting time in the late offset trimester for women with a history of early on-onset preeclampsia and preterm delivery at less than 34 0/7 weeks of gestation, or for women with more than ane prior pregnancy complicated by preeclampsia 1. The following twelvemonth, the U.Southward. Preventive Services Task Force (USPSTF) published a like guideline, although the listing of indications for depression-dose aspirin use was more than expansive Table ane two. The USPSTF guideline as well suggested that low-dose aspirin be considered in women with "several" moderate adventure factors for preeclampsia Table ane.

Low-Dose Aspirin Use During Pregnancy

Other wellness care organizations too have published guidelines for preeclampsia prevention using low-dose aspirin based on hazard factors. Published in 2011, the World Health System guideline recommended that low-dose aspirin (75 mg/day) exist initiated before twenty weeks of gestation for women at loftier risk of preeclampsia; eg, women with a history of preeclampsia, diabetes, chronic hypertension, renal disease, autoimmune disease, and multiple gestations 3. The National Institute of Health and Care Excellence published a quality statement, Antenatal Assessment of Pre-eclampsia Gamble, in July 2013 that asked health intendance providers to prescribe low-dose aspirin (75 mg/twenty-four hour period) to pregnant women at increased risk of preeclampsia at the beginning prenatal visit, to exist taken daily from 12 weeks of gestation until birth four. The degree of risk of preeclampsia was based on the presence of one or more loftier-chance factors (hypertensive disease in previous pregnancy, chronic kidney affliction autoimmune disease, type 1 or type two diabetes, and chronic hypertension) or more ane moderate-take chances factor (first pregnancy, maternal age of twoscore years or older, a body mass alphabetize greater than 35, family history of preeclampsia, and multiple pregnancy) 4.

Pathophysiology

Aspirin (acetylsalicylic acid) is a nonsteroidal antiinflammatory drug (NSAID) that works primarily through its inhibition of two cyclooxygenase isoenzymes (COX-ane and COX-2), which are necessary for prostaglandin biosynthesis. The COX-ane isoform is present in the vascular endothelium and regulates the production of prostacyclin and thromboxane A 2, prostaglandins with opposing regulatory furnishings on vascular homeostasis and platelet function. Prostacyclin is a potent vasodilator and inhibitor of platelet aggregation, whereas thromboxane A 2 (TXA2) is a stiff vasoconstrictor and promotes platelet aggregation. The COX-2 isoform is inducible and expressed almost exclusively following 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-1, resulting in decreased platelet synthesis of TXA2 without affecting vascular wall production of prostacyclin 5 6. At college doses, aspirin inhibits both COX-i and COX-ii, finer blocking all prostaglandin production.

Testify 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 because of its preferential inhibition of TXA2 at lower doses 7 8. However, it is likely that preeclampsia is a consequence of poor placentation from a variety of causes, including ischemia, reperfusion, or dysfunctional maternal inflammatory response towards the trophoblast 1 9. Whether low-dose aspirin improves early on placental perfusion is unknown, and as well, the precise machinery by which low-dose aspirin prevents preeclampsia in some women is also uncertain x 11.

Risks of Aspirin Use in Pregnancy

Maternal Risks

The majority of systematic reviews of randomized controlled trials (RCTs) have plant no increase in hemorrhagic complications associated with depression-dose aspirin during pregnancy 12 13 14. A USPSTF written report on low-dose aspirin for prevention of preeclampsia identified no increased take chances of placental abruption (eleven trials [23,332 women]; relative gamble [RR], 1.17; CI, 0.93–1.48), postpartum hemorrhage (nine trials [22,760 participants]; RR, 1.02; CI, 0.96–1.09), or mean claret loss (5 trials, [2,478 women]; RR not reported) 14. Long-term daily aspirin employ in non-significant adults (less than 300 mg/twenty-four hours for more than v years) has been associated with an increased run a risk of major gastrointestinal and cognitive bleeding episodes xv. In 1 RCT of low-dose aspirin during pregnancy for the prevention of preeclampsia, transfusion hazard was slightly greater in treated patients, (4.0% versus 3.2%) xvi.

Fetal Risks

Several systematic reviews of trials using low-dose aspirin for prevention of preeclampsia accept shown no increased risk of congenital anomalies 12 13 xiv. Moreover, a recent RCT of 1,228 women, 615 of whom received low-dose aspirin beginning before pregnancy and continuing throughout pregnancy, found no increased hazard of adverse fetal or neonatal effects associated with low-dose aspirin exposure 17. The number of built malformations as well was non constitute to exist increased among a cohort of nearly 15,000 women who reported aspirin use during the outset trimester 18. Still, concern has been raised about a possible association betwixt aspirin employ during pregnancy and gastroschisis 19 xx 21. A meta-analysis that included 5 case–command studies suggested that a history of aspirin use was twice as common in women with infants with gastroschisis compared with matched controls without gastroschisis 22. However, these data should be interpreted with extreme circumspection. In this meta-analysis, the dose of aspirin was not indicated (thus information technology is not articulate whether this applies to the utilize of low-dose aspirin), the study evaluated women using aspirin in the get-go trimester only and is subject to recollect bias, and at that place were a number of variables non controlled, including employ of other licit and illicit drugs in these trials.

The use of depression-dose aspirin (threescore–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 amongst more than 30,000 women treated in RCTs involving the written report of low-dose aspirin versus placebo for issue on a variety of outcomes 12 14 26.

The most recent Cochrane meta-assay did non discover an increased risk of neonatal intracranial hemorrhage (10 trials [26,184 infants]) or other neonatal hemorrhagic complications (viii trials [27,032 infants]) associated with maternal ingestion of low-dose aspirin during the tertiary trimester 12. Analysis of pooled data in the USPSTF systematic review was likewise reassuring, with no increase in intracerebral hemorrhage associated with low-dose aspirin utilise during pregnancy (x RCTs [22,158 women]; RR, 0.84; CI, 0.61–1.16) 14.

Contraindications to Aspirin Employ During Pregnancy

There are few absolute contraindications to aspirin therapy 27. Patients with a history of aspirin allergy (eg, urticaria) or hypersensitivity to other salicylates are at risk of anaphylaxis and should not receive depression-dose aspirin. Because of significant cross-sensitivity between aspirin and other nonsteroidal drugs, low-dose aspirin is also contraindicated in patients with known hypersensitivity to NSAIDs. Exposure to depression-dose aspirin in patients with nasal polyps may issue in life-threatening bronchoconstriction and should be avoided. The aforementioned is true in patients with asthma who have a history of aspirin-induced astute bronchospasm 27. Relative contraindications to depression-dose aspirin include a history of gastrointestinal bleeding, agile peptic ulcer affliction, other sources of gastrointestinal or genitourinary haemorrhage, and severe hepatic dysfunction. Reye syndrome has been reported rarely (less than one%) in children younger than xviii years who are given aspirin while recovering from viral illnesses, particularly flu and chickenpox. The decision to continue low-dose aspirin in the presence of obstetric bleeding or risk factors for obstetric haemorrhage should be considered on a case-by-example basis.

Timing of Use During Pregnancy

With the exception of studies of low-dose aspirin for prevention of early on pregnancy loss, the majority of trials using depression-dose aspirin during pregnancy have initiated treatment betwixt 12 weeks and 28 weeks of gestation. Some investigators have reported optimal results merely when treatment is started before 16 weeks 28 29 30 31. A contempo meta-analysis of aggregate data from 45 randomized trials reported only a small-scale reduction in preeclampsia when low-dose aspirin was started after 16 weeks (RR, 0.81; CI, 0.66–0.99) simply significant reductions in astringent preeclampsia (RR, 0.47; CI, 0.26–0.83) and fetal growth restriction (RR, 0.56; CI, 0.44–0.70) were demonstrated when low-dose aspirin was started before 16 weeks 31. In another meta-assay, which included information from the recent Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Show-Based Preeclampsia Prevention trial, the authors reported a reduction in preterm preeclampsia merely in the subgroup of patients in which aspirin was initiated before 16 weeks of gestation at a daily dose of 100 mg or more than (RR, 0.33; 95% CI, 0.19–0.57) 30. In contrast, another report pooled individual data from 31 high-quality randomized trials and found that the beneficial effects of low-dose aspirin were consistent, whether treatment was started before or after 16 weeks of gestation 32.

At that place is no apparent benefit to stopping low-dose aspirin before delivery. Written report protocols specific to pregnancy have varied, with some discontinuing low-dose aspirin at 36 weeks of gestation and others standing depression-dose aspirin until delivery 14 33 34 35. Discontinuation timing has not been related to excessive maternal or fetal haemorrhage. Likewise, low-dose aspirin utilize in the absence of other anticoagulants is not a contraindication to neuraxial blockade 36. Some patients present to intendance in the start trimester on low-dose aspirin. Whether start-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 be 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 modest trials suggested that low-dose aspirin may be beneficial for women at loftier hazard of preeclampsia 37 eight. However, until recently, this finding was not confirmed in larger RCTs 16 33 38, including a multicenter trial sponsored by the Eunice Kennedy Shriver National Constitute of Kid Wellness and Human Evolution, which included more than v,000 women 33. The 2017 Aspirin for Evidence-Based Preeclampsia Prevention trial randomized 1,776 women at loftier risk of preeclampsia based on a kickoff-trimester screening algorithm to 150-mg aspirin or placebo 39. The authors found a pregnant decrease in the rate of preterm preeclampsia (four.three% versus i.6%; odds ratio, 0.38; 95% CI, 0.xx–0.74). Although the 150-mg dose was used in this study, at that place are no bachelor studies comparing lx–80 mg versus 150 mg. Further, the screening algorithm used includes first-trimester serum markers, including placental growth factor and pregnancy-associated plasma protein-A, every bit well as uterine artery dopplers, which limits the generalizability to a U.Southward. population. Therefore, a higher dose or doubling of the available 81-mg dose cannot be recommended at this time.

A meta-analysis pooling private patient information from 31 RCTs showed a pocket-size effect of depression-dose aspirin prophylaxis on prevention of preeclampsia in groups of women with various risk profiles (RR, 0.xc; 95% CI, 0.84–0.97) 13. A subsequent Cochrane review, which pooled amass data from 59 trials, reported a 17% relative reduction in preeclampsia with depression-dose aspirin utilise 12. However, this large risk reduction may reflect publication bias (a small, early positive trial is more likely to be published) or chance findings because the largest trials in the analysis showed no pregnant protective effect.

The 2014 USPSTF guideline on depression-dose aspirin for prevention of morbidity and mortality from preeclampsia is based on the findings of their systematic review, which pooled data from 15 high-quality RCTs, thirteen of which reported preeclampsia incidence among women considered at highest adventure of disease Tabular array ane 2. A 24% reduction in preeclampsia (RR, 0.76; CI, 0.62–0.95) with depression-dose aspirin prophylaxis (60–150 mg/solar day) was demonstrated 14. However, the authors suggested this dramatic reduction in relative chance might be closer to 10% because of "small study effects" of most of the included trials. Depending on baseline preeclampsia risk, the relative gamble reduction with low-dose aspirin was associated with a pocket-sized subtract in an absolute take chances reduction of 2–5%.

Based on the findings from the USPSTF and others, low-dose aspirin prophylaxis (81 mg/solar day) later 12 weeks of gestation modestly reduces the gamble of preeclampsia in women at increased risk, without resulting in adverse fetal effects, increased maternal bleeding, or placental abruption. The recommendation to give depression-dose aspirin prophylaxis to high-gamble women is based on the number needed to care for in individual risk groups, which in turn is based on disease prevalence and treatment effect. In low-gamble groups (disease prevalence of 2%), the number needed to treat is approximately 500, compared with a number needed to care for of l women in a loftier-risk group with a disease prevalence of 20%. The USPSTF guideline recommends giving low-dose aspirin afterward 12 weeks of gestation to women with an absolute run a risk of preeclampsia of at least 8%, the lowest incidence of preeclampsia in control groups of studies included in their review 2. Based on historic and demographic risk factors, the USPSTF guideline recommends that women with any of the high-adventure factors for preeclampsia should receive depression-dose aspirin prophylaxis. Depression-dose aspirin prophylaxis should be considered in women with more than 1 of several moderate take a chance factors for preeclampsia Table 1.

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/day) prophylaxis is recommended in women at high hazard of preeclampsia and should be initiated betwixt 12 weeks and 28 weeks of gestation (optimally before sixteen weeks) and continued daily until delivery. Women who were receiving medically-indicated low-dose aspirin for other established medical indications before 12–28 weeks may go along with low-dose aspirin treatment.

Bereft Bear witness for Depression-Dose Aspirin

Stillbirth

Low-dose aspirin prophylaxis is non recommended for women with a history of stillbirth in the absence of risk factors for preeclampsia. Stillbirth and preeclampsia share many of the aforementioned risk factors, and when stillbirth is related to placental dysfunction, the underlying mechanisms are also likely similar. Few studies have focused solely on the outcome of low-dose aspirin prophylaxis on stillbirth. In one early on nonrandomized trial, investigators reported a nigh twofold increase in alive births when low-dose aspirin was given to women with at least one prior pregnancy loss at more than 13 weeks of gestation and a negative outcome on antiphospholipid antibody testing 40. Findings were similar in a retrospective cohort written report of 230 women with prior fetal loss at more than ten weeks of gestation 41. However, the results of prospectively collected stillbirth data from RCTs and meta-analyses designed to study the use of low-dose aspirin for preeclampsia prevention are inconclusive 12 13 14. Until additional supportive evidence becomes available, depression-dose aspirin prophylaxis is not recommended solely for the indication of prior unexplained stillbirth in the absenteeism of chance factors for preeclampsia.

Fetal Growth Restriction

Depression-dose aspirin prophylaxis for prevention of recurrent fetal growth brake is similarly not currently recommended in women without other risk factors for preeclampsia because of insufficient evidence in women with an isolated history of fetal growth restriction. However, in women at run a risk of preeclampsia, prophylaxis with depression-dose aspirin (peculiarly when initiated less than sixteen weeks of gestation) may reduce the run a risk of fetal growth restriction. Abnormal placentation resulting in poor placental perfusion (ie, placental insufficiency) is the virtually common pathology associated with fetal growth restriction 42. Some investigators take suggested that low-dose aspirin, initiated early in the beginning trimester, may preclude fetal growth brake through its inhibitory action on platelet assemblage and improvement in placental development 43 44. I written report first reported that low-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 written report did not identify which women were well-nigh likely to benefit from low-dose aspirin 46. There are currently no well-powered RCTs evaluating the office of depression-dose aspirin in the prevention of recurrent fetal growth restriction in otherwise low-take chances women. Systematic reviews of low-dose aspirin when used in the setting of preeclampsia prevention take consistently reported a 10–twenty% reduction in fetal growth restriction or infants who were small for gestational age 12 thirteen xiv 29 30 31 32. Evidence as to whether starting depression-dose aspirin earlier 16 weeks of gestation influences the degree to which low-dose aspirin is beneficial in reducing fetal growth restriction is inconclusive, though some meta-analyses take suggested improved do good with earlier initiation 29 xxx 31 32. Currently, because the bulk of show supporting a reduction of fetal growth restriction from low-dose aspirin prophylaxis comes from studies of women who were likewise at risk of preeclampsia—not with histories of fetal growth restriction lone—there is insufficient evidence to support the use of low-dose aspirin for fetal growth restriction prophylaxis in the absence of other hazard factors for preeclampsia.

Preterm Birth

The effect of low-dose aspirin on preterm nascency as a primary outcome remains understudied. However, until evidence from loftier-quality studies directed towards prevention of spontaneous preterm birth become available, depression-dose aspirin prophylaxis for prevention of spontaneous preterm birth, in the absence of take chances factors for preeclampsia, is not recommended.

Aspirin has been shown to subtract uterine contractility by inhibiting COX-dependent prostaglandin synthesis 47. High doses of aspirin have been studied to care for preterm labor, but the irreversible binding to COX-2 and adverse maternal and fetal effects of high-dose aspirin prohibit its utilise in the clinical setting. Low-dose aspirin has been reported to reduce preterm birth (at less than 37 weeks of gestation) in 8–xiv% of women at gamble of preeclampsia 12 thirteen 14 32. However, whether this reflects a reduction in medically indicated or spontaneous preterm births is not articulate in nearly studies. A contempo 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 report, treatment with low-dose aspirin resulted in a seven% reduction in the hazard of spontaneous preterm birth at fewer than 37 weeks (RR, 0.93; 95% CI, 0.86–0.996) and a 14% reduction in spontaneous preterm nativity at fewer than 34 weeks (RR, 0.86; 95% CI, 0.76–0.99) compared with controls. Spontaneous preterm birth at fewer than 28 weeks was reduced past nineteen%, but the difference was non statistically significant (RR, 0.81; 95% CI, 0.59–1.1) 48. Another written report using data 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 before pregnancy and connected through pregnancy, was not associated with a reduction in overall preterm births (RR, 0.72; 95% CI, 0.42–1.23), spontaneous preterm birth (RR, 0.51; 95% CI, 0.xix–1.34), or medically indicated preterm birth (RR, 0.89; 95% CI, 0.44–1.eighty) 49.

Indications for Which At that place Is No Benefit for Low-Dose Aspirin

Early Pregnancy Loss

The combination of low-dose aspirin and unfractionated or depression-molecular-weight heparin has been shown to reduce the run a risk of early on pregnancy loss in women with antiphospholipid syndrome l. Withal, low-dose aspirin has non been shown to foreclose unexplained early pregnancy loss in women who do not have antiphospholipid syndrome. Pooling data from two trials (256 participants), one study reported no increase in live births among women treated with depression-dose aspirin compared with placebo (RR: 0.94, CI, 0.lxxx–i.11) 51. A 2014 study too reported no departure in live births when 1,078 women with one or two prior pregnancy losses were given depression-dose aspirin or placebo before pregnancy (58% versus 53%, P=.0984). Pregnancy loss occurred in thirteen% of 535 women given low-dose aspirin compared with 12% of 543 women in the placebo group ( P=.7812) 35. Based on the bachelor evidence, the use of low-dose aspirin prophylaxis is non recommended for the prevention of early pregnancy loss.

Conclusions

Daily low-dose aspirin use in pregnancy is considered safe and is associated with a low likelihood of serious maternal, or fetal complications, or both, related to utilise. The American Higher of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine support the USPSTF guideline criteria for prevention of preeclampsia. Depression-dose aspirin (81 mg/d) prophylaxis is recommended in women at high take a chance of preeclampsia and should exist initiated betwixt 12 weeks and 28 weeks of gestation (optimally before xvi weeks) and continued daily until delivery. Depression-dose aspirin prophylaxis should be considered for women with more than than i of several moderate gamble factors for preeclampsia. Women at gamble of preeclampsia are divers based on the presence of one or more loftier-run a risk factors (history of preeclampsia, multifetal gestation, renal disease, autoimmune affliction, type 1 or type 2 diabetes, and chronic hypertension) or more than one moderate-adventure gene (first pregnancy, maternal age of 35 years or older, a trunk mass index greater than 30, family history of preeclampsia, sociodemographic characteristics, and personal history factors) Table i. In the absence of high-risk factors for preeclampsia, current bear witness does not support the use of safe 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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Low-dose aspirin use during pregnancy. ACOG Committee Opinion 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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