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Women pregnant with twins or with a previous diagnosis of pre-eclampsia or high blood pressure may benefit less from aspirin than those with other issues such as body mass index greater than 35 or insulin resistance.

Pre-eclampsia (PE) affects 2.1–5.6% of pregnancies and is the second leading cause of maternal mortality worldwide. In addition to developing hypertension, it can cause short-term consequences, such as the malfunctioning of both the liver and kidneys, and long-term consequences, including cardiovascular abnormalities. Therefore, the World Health Organization suggests taking low-dose aspirin as a preventative measure for high-risk pregnant women.

This study, published in the Journal of Maternal-Fetal & Neonatal Medicine, aimed to assess the risk factors for PE in women who use aspirin. This research included data from 2011 to 2015 from 70 centers in 5 different countries. Patients were included if they were using aspirin before the 16th week of pregnancy and had risk factors for PE, such as diabetes, high blood pressure, gestating twins, a history of pre-eclampsia, or having a body mass index (BMI) greater than 35.

Trends of Term and Pre-Term Pre-Eclampsia
This study included 2296 pregnant women for whom comprehensive details on aspirin were provided. Although all women were at significant risk of pre-eclampsia at the start and were eligible for aspirin, only 660 (28.7%) received it, with 548 women (83.03%) using low-dose aspirin, whereas 112 women (16.97%) were on high-dose aspirin. Additionally, out of 600 people who received aspirin, 132 (20%) went on to develop term PE, and 60 (9.09%) experienced pre-term PE, which increased awareness of PE risk factors.

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Prominent Risk Factors for Pre-Eclampsia
Twins, a previous diagnosis of PE, and high blood pressure were the risk factors for pre-eclampsia among pregnant women using aspirin. Similar results were discovered for pre-term PE. Diabetes and BMI greater than 35 did not show any significant differences. Meanwhile, this study did not evaluate the immediate and long-term impacts of PE.

Identifying Obstacles Associated With Aspirin as a Prophylaxis
Less than one-third were taking aspirin daily before 16 weeks of pregnancy. Several factors affect prescribing patterns and drug compliance in identifying the obstacle inquiry related to aspirin, such as concern about probable fetal harm. 

The study suggests that a continued search for preventative medications and symptom treatment is still essential in addition to the current low-dose aspirin guidelines.

Source:

Muldoon, K. A., McLean, C., El-Chaár, D., Corsi, D. J., Rybak, N., Dagvadorj, A., Guo, Y., White, R. R., Dingwall-Harvey, A. L. J., Gaudet, L. M., Walker, M. C., & Wen, S. W. (2023). Persisting risk factors for preeclampsia among high-risk pregnancies already using prophylactic aspirin: a multi-country retrospective investigation. Journal of Maternal-fetal & Neonatal Medicine, 36(1). https://doi.org/10.1080/14767058.2023.2200879