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When Is Best Time to Take Baby Aspirin

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Committee on Obstetric Exercise

Society for Maternal–Fetal Medicine:

This Committee Opinion was developed past the Commission on Obstetric Practise in collaboration with committee member T. Flint Porter, Doctor, and the Society for Maternal–Fetal Medicine in collaboration with members Cynthia Gyamfi-Bannerman, Md, MS, and Tracy Manuck, MD.

ABSTRACT: Low-dose aspirin has been used during pregnancy, virtually commonly to prevent or delay the onset of preeclampsia. The American College of Obstetricians and Gynecologists issued the Hypertension in Pregnancy Chore Forcefulness 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 1 prior pregnancy complicated by preeclampsia. The U.S. Preventive Services Chore Strength published a similar guideline, although the listing of indications for low-dose aspirin use was more expansive. Daily low-dose aspirin utilize in pregnancy is considered safe and is associated with a low likelihood of serious maternal, or fetal complications, or both, related to apply. The American College of Obstetricians and Gynecologists and the Social club for Maternal-Fetal Medicine support the U.Due south. Preventive Services Task Forcefulness guideline criteria for prevention of preeclampsia. Depression-dose aspirin (81 mg/24-hour interval) prophylaxis is recommended in women at loftier gamble of preeclampsia and should be initiated betwixt 12 weeks and 28 weeks of gestation (optimally before xvi weeks) and connected daily until delivery. Depression-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 than high-take chances factors (history of preeclampsia, multifetal gestation, renal disease, autoimmune disease, type i or type 2 diabetes, and chronic hypertension) or more than than i of several moderate-risk factors (first pregnancy, maternal age of 35 years or older, a body mass index greater than xxx, family history of preeclampsia, sociodemographic characteristics, and personal history factors). In the absence of high gamble factors for preeclampsia, current evidence does non support the employ of condom low-dose aspirin for the prevention of early pregnancy loss, fetal growth restriction, stillbirth, or preterm birth.

Recommendations

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

  • Low-dose aspirin (81 mg/day) prophylaxis is recommended in women at high run a risk 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 1 of several moderate gamble factors for preeclampsia.

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

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

  • Low-dose aspirin prophylaxis is not recommended for the prevention of spontaneous preterm birth, in the absence of take chances 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. Low-dose aspirin has been used during pregnancy most commonly to foreclose or filibuster 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. Recent systematic reviews of low-dose aspirin use during pregnancy have improved our understanding of the part of depression-dose aspirin in each of these clinical situations. Despite this, the use of low-dose aspirin in clinical obstetrics exercise remains varied. The purpose of this document is to summarize the evidence and provide 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 available in the United states (81 mg).

Groundwork

In Nov 2013, ACOG issued the Hypertension in Pregnancy Task Forcefulness Report recommending daily low-dose aspirin offset in the belatedly commencement 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 one prior pregnancy complicated by preeclampsia 1. The following year, the U.S. Preventive Services Task Forcefulness (USPSTF) published a similar guideline, although the list of indications for low-dose aspirin use was more than expansive Table 1 two. The USPSTF guideline as well suggested that low-dose aspirin be considered in women with "several" moderate adventure factors for preeclampsia Tabular array 1.

Low-Dose Aspirin Use During Pregnancy

Other wellness care organizations too have published guidelines for preeclampsia prevention using depression-dose aspirin based on run a risk factors. Published in 2011, the World Health Arrangement guideline recommended that depression-dose aspirin (75 mg/24-hour interval) 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 disease, autoimmune disease, and multiple gestations 3. The National Establish of Health and Care Excellence published a quality statement, Antenatal Cess 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 risk of preeclampsia at the start prenatal visit, to be taken daily from 12 weeks of gestation until birth 4. The degree of take chances of preeclampsia was based on the presence of 1 or more high-risk factors (hypertensive illness in previous pregnancy, chronic kidney illness autoimmune disease, type 1 or type 2 diabetes, and chronic hypertension) or more than one moderate-risk factor (first pregnancy, maternal historic period of 40 years or older, a body mass index greater than 35, family history of preeclampsia, and multiple pregnancy) iv.

Pathophysiology

Aspirin (acetylsalicylic acid) is a nonsteroidal antiinflammatory drug (NSAID) that works primarily through its inhibition of ii cyclooxygenase isoenzymes (COX-ane and COX-2), which are necessary for prostaglandin biosynthesis. The COX-1 isoform is nowadays in the vascular endothelium and regulates the production of prostacyclin and thromboxane A ii, prostaglandins with opposing regulatory effects on vascular homeostasis and platelet role. Prostacyclin is a potent vasodilator and inhibitor of platelet assemblage, whereas thromboxane A 2 (TXA2) is a potent vasoconstrictor and promotes platelet aggregation. The COX-2 isoform is inducible and expressed almost exclusively following exposure to cytokines or other inflammatory mediators. The upshot of aspirin on COX-dependent prostaglandin synthesis is dose dependent. At lower dosages (60–150 mg/day) aspirin irreversibly acetylates COX-ane, 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.

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 7 viii. However, information technology is likely that preeclampsia is a issue of poor placentation from a variety of causes, including ischemia, reperfusion, or dysfunctional maternal inflammatory response towards the trophoblast i 9. 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 likewise uncertain x 11.

Risks of Aspirin Use in Pregnancy

Maternal Risks

The majority of systematic reviews of randomized controlled trials (RCTs) have establish no increase in hemorrhagic complications associated with low-dose aspirin during pregnancy 12 13 xiv. A USPSTF report on low-dose aspirin for prevention of preeclampsia identified no increased gamble of placental abruption (11 trials [23,332 women]; relative take a chance [RR], one.17; CI, 0.93–1.48), postpartum hemorrhage (nine trials [22,760 participants]; RR, 1.02; CI, 0.96–1.09), or mean blood loss (five trials, [2,478 women]; RR not reported) 14. Long-term daily aspirin use in non-pregnant adults (less than 300 mg/solar day for more than 5 years) has been associated with an increased adventure of major gastrointestinal and cognitive bleeding episodes xv. In one RCT of depression-dose aspirin during pregnancy for the prevention of preeclampsia, transfusion run a risk was slightly greater in treated patients, (4.0% versus 3.2%) 16.

Fetal Risks

Several systematic reviews of trials using low-dose aspirin for prevention of preeclampsia have shown no increased risk of congenital anomalies 12 13 14. Moreover, a recent RCT of 1,228 women, 615 of whom received depression-dose aspirin beginning before pregnancy and continuing throughout pregnancy, found no increased risk of adverse fetal or neonatal furnishings associated with depression-dose aspirin exposure 17. The number of built malformations also was not institute to be increased amongst a accomplice of nearly fifteen,000 women who reported aspirin use during the beginning trimester 18. Even so, concern has been raised about a possible association between aspirin use during pregnancy and gastroschisis 19 20 21. A meta-analysis that included five instance–control 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. Yet, these data 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 use of low-dose aspirin), the study evaluated women using aspirin in the outset trimester only and is subject to call back bias, and there were a number of variables non controlled, including use of other licit and illicit drugs in these trials.

The use of low-dose aspirin (lx–150 mg) in the third trimester has not been associated with ductal closure 23 24. Older animate being 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 contrast to this and other studies that did not differentiate type of dose of NSAID exposure, no increase in perinatal deaths from persistent pulmonary hypertension in the neonate has been reported amidst more than 30,000 women treated in RCTs involving the written report of depression-dose aspirin versus placebo for effect on a variety of outcomes 12 14 26.

The most recent Cochrane meta-analysis did not notice an increased chance of neonatal intracranial hemorrhage (x trials [26,184 infants]) or other neonatal hemorrhagic complications (8 trials [27,032 infants]) associated with maternal ingestion of low-dose aspirin during the third 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 use during pregnancy (ten RCTs [22,158 women]; RR, 0.84; CI, 0.61–one.16) 14.

Contraindications to Aspirin Use During Pregnancy

In that location are few absolute contraindications to aspirin therapy 27. Patients with a history of aspirin allergy (eg, urticaria) or hypersensitivity to other salicylates are at adventure of anaphylaxis and should not receive depression-dose aspirin. Because of significant cross-sensitivity betwixt aspirin and other nonsteroidal drugs, low-dose aspirin is also contraindicated in patients with known hypersensitivity to NSAIDs. Exposure to low-dose aspirin in patients with nasal polyps may event in life-threatening bronchoconstriction and should exist avoided. The same is truthful in patients with asthma who have a history of aspirin-induced acute 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 depression-dose aspirin in the presence of obstetric bleeding or risk factors for obstetric bleeding should exist considered on a case-by-case footing.

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 low-dose aspirin during pregnancy have initiated treatment between 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 recent meta-assay of aggregate information from 45 randomized trials reported only a small reduction in preeclampsia when low-dose aspirin was started afterwards 16 weeks (RR, 0.81; CI, 0.66–0.99) but significant reductions in severe preeclampsia (RR, 0.47; CI, 0.26–0.83) and fetal growth brake (RR, 0.56; CI, 0.44–0.70) were demonstrated when depression-dose aspirin was started before 16 weeks 31. In some other meta-assay, which included information from the recent Combined Multimarker Screening and Randomized Patient Handling with Aspirin for Evidence-Based Preeclampsia Prevention trial, the authors reported a reduction in preterm preeclampsia just 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 contrast, another written report pooled individual data from 31 high-quality randomized trials and establish that the benign effects of low-dose aspirin were consistent, whether treatment was started before or later on 16 weeks of gestation 32.

There is no apparent benefit to stopping low-dose aspirin before delivery. Study protocols specific to pregnancy have varied, with some discontinuing depression-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. As well, depression-dose aspirin use in the absence of other anticoagulants is non a contraindication to neuraxial blockade 36. Some patients present to care in the first trimester on low-dose aspirin. Whether first-trimester exposure is associated with adverse fetal effects or maternal benefit is not known.

Indications for Depression-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 depression-dose aspirin may be beneficial for women at high hazard of preeclampsia 37 8. Nevertheless, until recently, this finding was not confirmed in larger RCTs xvi 33 38, including a multicenter trial sponsored past the Eunice Kennedy Shriver National Establish of Child Health and Human being Development, which included more than 5,000 women 33. The 2017 Aspirin for Evidence-Based Preeclampsia Prevention trial randomized 1,776 women at high risk of preeclampsia based on a commencement-trimester screening algorithm to 150-mg aspirin or placebo 39. The authors establish a meaning subtract in the rate of preterm preeclampsia (4.iii% versus 1.half dozen%; 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 available studies comparing sixty–lxxx mg versus 150 mg. Further, the screening algorithm used includes commencement-trimester serum markers, including placental growth factor and pregnancy-associated plasma poly peptide-A, as well as uterine artery dopplers, which limits the generalizability to a U.S. 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 outcome of low-dose aspirin prophylaxis on prevention of preeclampsia in groups of women with various risk profiles (RR, 0.90; 95% CI, 0.84–0.97) thirteen. A subsequent Cochrane review, which pooled aggregate data from 59 trials, reported a 17% relative reduction in preeclampsia with low-dose aspirin use 12. All the same, this large gamble reduction may reflect publication bias (a modest, early positive trial is more likely to be published) or take chances findings because the largest trials in the analysis showed no significant protective effect.

The 2014 USPSTF guideline on low-dose aspirin for prevention of morbidity and mortality from preeclampsia is based on the findings of their systematic review, which pooled information from 15 loftier-quality RCTs, 13 of which reported preeclampsia incidence among women considered at highest gamble of disease Table ane ii. A 24% reduction in preeclampsia (RR, 0.76; CI, 0.62–0.95) with low-dose aspirin prophylaxis (60–150 mg/day) was demonstrated 14. However, the authors suggested this dramatic reduction in relative risk might be closer to 10% because of "modest written report effects" of almost of the included trials. Depending on baseline preeclampsia risk, the relative hazard reduction with low-dose aspirin was associated with a pocket-sized subtract in an accented risk reduction of 2–5%.

Based on the findings from the USPSTF and others, low-dose aspirin prophylaxis (81 mg/solar day) afterward 12 weeks of gestation modestly reduces the adventure 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 loftier-risk women is based on the number needed to treat in private risk groups, which in plow is based on illness prevalence and treatment effect. In low-risk groups (affliction prevalence of 2%), the number needed to treat is approximately 500, compared with a number needed to treat of fifty women in a high-gamble grouping with a illness prevalence of twenty%. The USPSTF guideline recommends giving low-dose aspirin later 12 weeks of gestation to women with an accented 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 than one of several moderate take chances factors for preeclampsia Table 1.

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

Insufficient Evidence for Low-Dose Aspirin

Stillbirth

Low-dose aspirin prophylaxis is not recommended for women with a history of stillbirth in the absence of 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 likewise likely similar. Few studies have focused solely on the result 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 to the lowest degree ane prior pregnancy loss at more 13 weeks of gestation and a negative issue on antiphospholipid antibiotic testing 40. Findings were like in a retrospective cohort written report of 230 women with prior fetal loss at more x weeks of gestation 41. However, the results of prospectively collected stillbirth information from RCTs and meta-analyses designed to study the apply 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 risk factors for preeclampsia.

Fetal Growth Restriction

Low-dose aspirin prophylaxis for prevention of recurrent fetal growth restriction is similarly non currently recommended in women without other adventure factors for preeclampsia because of bereft evidence in women with an isolated history of fetal growth brake. However, in women at risk of preeclampsia, prophylaxis with low-dose aspirin (particularly when initiated less than 16 weeks of gestation) may reduce the take chances of fetal growth restriction. Abnormal placentation resulting in poor placental perfusion (ie, placental insufficiency) is the virtually mutual pathology associated with fetal growth brake 42. Some investigators have suggested that low-dose aspirin, initiated early in the first trimester, may prevent fetal growth brake through its inhibitory action on platelet aggregation and improvement in placental development 43 44. One study offset 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 not place which women were near likely 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-hazard women. Systematic reviews of low-dose aspirin when used in the setting of preeclampsia prevention have consistently reported a ten–20% reduction in fetal growth restriction or infants who were small for gestational age 12 13 14 29 30 31 32. Show as to whether starting low-dose aspirin before sixteen weeks of gestation influences the degree to which low-dose aspirin is beneficial in reducing fetal growth restriction is inconclusive, though some meta-analyses have suggested improved benefit with earlier initiation 29 xxx 31 32. Currently, considering the bulk of evidence supporting a reduction of fetal growth restriction from low-dose aspirin prophylaxis comes from studies of women who were also at risk of preeclampsia—not with histories of fetal growth restriction alone—in that location is insufficient evidence to back up the use of low-dose aspirin for fetal growth restriction prophylaxis in the absence of other run a risk factors for preeclampsia.

Preterm Birth

The effect of low-dose aspirin on preterm nativity equally a principal 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 risk factors for preeclampsia, is not recommended.

Aspirin has been shown to subtract uterine contractility past inhibiting COX-dependent prostaglandin synthesis 47. Loftier doses of aspirin accept been studied to treat preterm labor, only the irreversible bounden to COX-two and agin maternal and fetal furnishings of high-dose aspirin prohibit its use in the clinical setting. Low-dose aspirin has been reported to reduce preterm birth (at less than 37 weeks of gestation) in 8–14% 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 most studies. A recent systematic review and meta-assay 48 analyzed individual patient information from 17 trials of preeclampsia prevention (28,797 participants) that supplied sufficient item regarding whether delivery was spontaneous or medically indicated. In that report, treatment with low-dose aspirin resulted in a 7% reduction in the hazard 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 nativity at fewer than 28 weeks was reduced by 19%, simply the difference was not statistically significant (RR, 0.81; 95% CI, 0.59–one.1) 48. Another study using data from a randomized controlled trial of low-dose aspirin versus placebo given to women with a history of pregnancy loss reported that depression-dose aspirin, started before pregnancy and continued 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, 0.19–1.34), or medically indicated preterm birth (RR, 0.89; 95% CI, 0.44–1.80) 49.

Indications for Which There Is No Benefit for Low-Dose Aspirin

Early Pregnancy Loss

The combination of depression-dose aspirin and unfractionated or low-molecular-weight heparin has been shown to reduce the risk of early on pregnancy loss in women with antiphospholipid syndrome 50. Still, low-dose aspirin has not been shown to preclude unexplained early pregnancy loss in women who practice not accept antiphospholipid syndrome. Pooling information from two trials (256 participants), ane report reported no increase in alive births among women treated with low-dose aspirin compared with placebo (RR: 0.94, CI, 0.lxxx–one.eleven) 51. A 2014 study as well reported no difference in live births when 1,078 women with one or two prior pregnancy losses were given low-dose aspirin or placebo before pregnancy (58% versus 53%, P=.0984). Pregnancy loss occurred in xiii% of 535 women given low-dose aspirin compared with 12% of 543 women in the placebo group ( P=.7812) 35. Based on the available evidence, the use of low-dose aspirin prophylaxis is not 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 use. The American College of Obstetricians and Gynecologists and the Order 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 16 weeks) and continued daily until delivery. Low-dose aspirin prophylaxis should be considered for women with more than 1 of several moderate risk factors for preeclampsia. Women at run a risk of preeclampsia are defined based on the presence of one or more than high-risk factors (history of preeclampsia, multifetal gestation, renal disease, autoimmune disease, blazon ane or type two diabetes, and chronic hypertension) or more one moderate-take chances cistron (offset pregnancy, maternal age of 35 years or older, a body mass alphabetize greater than xxx, family history of preeclampsia, sociodemographic characteristics, and personal history factors) Table one. In the absenteeism of high-risk factors for preeclampsia, electric current testify does non back up the use of prophylactic depression-dose aspirin for the prevention of early pregnancy loss, fetal growth brake, stillbirth, or preterm birth.

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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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