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Is It Ok to Take Cold Eeze With Baby Aspirin

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Committee on Obstetric Practice

Order for Maternal–Fetal Medicine:

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

Abstruse: Low-dose aspirin has been used during pregnancy, most ordinarily to preclude or delay the onset of preeclampsia. The American College of Obstetricians and Gynecologists issued the Hypertension in Pregnancy Task Force Written report recommending daily depression-dose aspirin commencement in the tardily 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 ane prior pregnancy complicated by preeclampsia. The U.S. Preventive Services Task Forcefulness published a similar guideline, although the list of indications for low-dose aspirin employ was more expansive. Daily low-dose aspirin apply in pregnancy is considered condom 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 Society for Maternal-Fetal Medicine support the U.Southward. Preventive Services Job Force guideline criteria for prevention of preeclampsia. Low-dose aspirin (81 mg/day) 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 commitment. Low-dose aspirin prophylaxis should exist considered for women with more than 1 of several moderate run a risk factors for preeclampsia. Women at risk of preeclampsia are defined based on the presence of one or more high-risk factors (history of preeclampsia, multifetal gestation, renal illness, autoimmune disease, type i or type 2 diabetes, and chronic hypertension) or more than than i of several moderate-hazard factors (get-go pregnancy, maternal age of 35 years or older, a body mass index greater than thirty, family unit history of preeclampsia, sociodemographic characteristics, and personal history factors). In the absence of high risk factors for preeclampsia, current evidence does not back up the utilize of condom depression-dose aspirin for the prevention of early on pregnancy loss, fetal growth brake, stillbirth, or preterm birth.

Recommendations

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

  • Low-dose aspirin (81 mg/day) prophylaxis is recommended in women at loftier risk of preeclampsia and should exist initiated between 12 weeks and 28 weeks of gestation (optimally earlier 16 weeks) and connected daily until commitment.

  • Depression-dose aspirin prophylaxis should exist considered for women with more than i of several moderate risk factors for preeclampsia.

  • Depression-dose aspirin prophylaxis is non 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 run a risk factors for preeclampsia.

  • Depression-dose aspirin prophylaxis is not recommended for the prevention of spontaneous preterm nascence, in the absence of risk 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 prevent or delay the onset of preeclampsia. Other suggested indications for low-dose aspirin have included prevention of stillbirth, fetal growth restriction, preterm nativity, and early pregnancy loss. Recent systematic reviews of depression-dose aspirin use during pregnancy have improved our agreement of the role of depression-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 current recommendations regarding the use of depression-dose aspirin in pregnancy. It should exist noted that although systematic reviews and consensus statements have used dissimilar doses of depression-dose aspirin, this certificate will consider only the depression-dose aspirin bachelor in the Us (81 mg).

Background

In Nov 2013, ACOG issued the Hypertension in Pregnancy Chore Force Report recommending daily depression-dose aspirin showtime in the belatedly starting time 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 one prior pregnancy complicated past preeclampsia 1. The post-obit twelvemonth, the U.S. Preventive Services Task Forcefulness (USPSTF) published a similar guideline, although the list of indications for low-dose aspirin apply was more than expansive Tabular array 1 2. The USPSTF guideline also suggested that low-dose aspirin exist considered in women with "several" moderate run a risk factors for preeclampsia Tabular array ane.

Low-Dose Aspirin Use During Pregnancy

Other health care organizations also have published guidelines for preeclampsia prevention using low-dose aspirin based on risk factors. Published in 2011, the World Health Organization guideline recommended that low-dose aspirin (75 mg/twenty-four hours) 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 affliction, and multiple gestations 3. The National Institute of Health and Care Excellence published a quality statement, Antenatal Assessment of Pre-eclampsia Chance, 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 offset prenatal visit, to exist taken daily from 12 weeks of gestation until birth 4. The degree of take chances of preeclampsia was based on the presence of i or more high-risk factors (hypertensive affliction in previous pregnancy, chronic kidney illness autoimmune disease, type ane or type ii diabetes, and chronic hypertension) or more than i moderate-run a risk factor (first pregnancy, maternal age 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 two cyclooxygenase isoenzymes (COX-1 and COX-2), which are necessary for prostaglandin biosynthesis. The COX-1 isoform is present in the vascular endothelium and regulates the production of prostacyclin and thromboxane A two, prostaglandins with opposing regulatory effects on vascular homeostasis and platelet role. Prostacyclin is a potent vasodilator and inhibitor of platelet assemblage, whereas thromboxane A two (TXA2) is a potent vasoconstrictor and promotes platelet aggregation. The COX-2 isoform is inducible and expressed near exclusively post-obit exposure to cytokines or other inflammatory mediators. The effect of aspirin on COX-dependent prostaglandin synthesis is dose dependent. At lower dosages (sixty–150 mg/day) aspirin irreversibly acetylates COX-i, resulting in decreased platelet synthesis of TXA2 without affecting vascular wall product of prostacyclin 5 vi. At higher doses, aspirin inhibits both COX-ane and COX-two, effectively 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 because of its preferential inhibition of TXA2 at lower doses 7 8. However, information technology is likely that preeclampsia is a result of poor placentation from a variety of causes, including ischemia, reperfusion, or dysfunctional maternal inflammatory response towards the trophoblast 1 nine. Whether low-dose aspirin improves early placental perfusion is unknown, and too, the precise mechanism by which low-dose aspirin prevents preeclampsia in some women is also uncertain 10 11.

Risks of Aspirin Apply in Pregnancy

Maternal Risks

The majority of systematic reviews of randomized controlled trials (RCTs) have found no increase in hemorrhagic complications associated with low-dose aspirin during pregnancy 12 13 fourteen. A USPSTF report on low-dose aspirin for prevention of preeclampsia identified no increased run a risk of placental abruption (11 trials [23,332 women]; relative risk [RR], 1.17; CI, 0.93–1.48), postpartum hemorrhage (nine trials [22,760 participants]; RR, i.02; CI, 0.96–1.09), or mean blood loss (v trials, [two,478 women]; RR not reported) 14. Long-term daily aspirin use in non-meaning adults (less than 300 mg/day for more than v years) has been associated with an increased risk of major gastrointestinal and cerebral haemorrhage episodes 15. In one RCT of low-dose aspirin during pregnancy for the prevention of preeclampsia, transfusion gamble was slightly greater in treated patients, (iv.0% versus three.ii%) 16.

Fetal Risks

Several systematic reviews of trials using low-dose aspirin for prevention of preeclampsia have shown no increased gamble of congenital anomalies 12 13 14. Moreover, a recent RCT of 1,228 women, 615 of whom received low-dose aspirin beginning before pregnancy and continuing throughout pregnancy, establish no increased risk of adverse fetal or neonatal effects associated with low-dose aspirin exposure 17. The number of congenital malformations also was not institute to be increased among a cohort of nearly 15,000 women who reported aspirin use during the first trimester 18. Nonetheless, concern has been raised about a possible association between aspirin use during pregnancy and gastroschisis nineteen 20 21. A meta-analysis that included five example–control studies suggested that a history of aspirin utilize was twice as common in women with infants with gastroschisis compared with matched controls without gastroschisis 22. Yet, these information should be interpreted with farthermost circumspection. In this meta-analysis, the dose of aspirin was not indicated (thus it is not clear whether this applies to the employ of low-dose aspirin), the study evaluated women using aspirin in the first trimester only and is subject to recollect bias, and there were a number of variables not controlled, including utilise of other licit and illicit drugs in these trials.

The use of low-dose aspirin (60–150 mg) in the third trimester has not been associated with ductal closure 23 24. Older beast studies suggested a relationship betwixt in utero exposure to NSAIDs in full general and premature closure of the ductus arteriosus resulting in persistent pulmonary hypertension in the neonate 25. Still, 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 among more than xxx,000 women treated in RCTs involving the study of low-dose aspirin versus placebo for consequence on a variety of outcomes 12 14 26.

The most recent Cochrane meta-analysis did not detect an increased risk of neonatal intracranial hemorrhage (10 trials [26,184 infants]) or other neonatal hemorrhagic complications (eight 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 also reassuring, with no increase in intracerebral hemorrhage associated with low-dose aspirin use during pregnancy (10 RCTs [22,158 women]; RR, 0.84; CI, 0.61–1.16) xiv.

Contraindications to Aspirin Use 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 low-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 low-dose aspirin in patients with nasal polyps may consequence in life-threatening bronchoconstriction and should be avoided. The aforementioned is true in patients with asthma who accept a history of aspirin-induced acute bronchospasm 27. Relative contraindications to depression-dose aspirin include a history of gastrointestinal bleeding, active peptic ulcer disease, other sources of gastrointestinal or genitourinary bleeding, and severe hepatic dysfunction. Reye syndrome has been reported rarely (less than 1%) in children younger than eighteen years who are given aspirin while recovering from viral illnesses, particularly flu and chickenpox. The decision to proceed depression-dose aspirin in the presence of obstetric haemorrhage or risk factors for obstetric bleeding should be considered on a case-by-instance basis.

Timing of Use During Pregnancy

With the exception of studies of low-dose aspirin for prevention of early 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 accept reported optimal results only when treatment is started earlier sixteen weeks 28 29 30 31. A recent meta-analysis of aggregate data from 45 randomized trials reported only a modest reduction in preeclampsia when low-dose aspirin was started later on 16 weeks (RR, 0.81; CI, 0.66–0.99) merely 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 sixteen weeks 31. In another meta-analysis, which included data from the recent Combined Multimarker Screening and Randomized Patient Treatment 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 xvi weeks of gestation at a daily dose of 100 mg or more (RR, 0.33; 95% CI, 0.xix–0.57) 30. In contrast, some other report pooled individual data from 31 loftier-quality randomized trials and establish that the beneficial effects of depression-dose aspirin were consistent, whether treatment was started before or after 16 weeks of gestation 32.

There is no apparent benefit to stopping low-dose aspirin earlier delivery. Study protocols specific to pregnancy have varied, with some discontinuing depression-dose aspirin at 36 weeks of gestation and others continuing depression-dose aspirin until delivery fourteen 33 34 35. Discontinuation timing has not been related to excessive maternal or fetal bleeding. Likewise, low-dose aspirin use in the absence of other anticoagulants is not a contraindication to neuraxial blockade 36. Some patients present to care in the starting time trimester on low-dose aspirin. Whether commencement-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 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 risk of preeclampsia 37 8. All the same, until recently, this finding was not confirmed in larger RCTs xvi 33 38, including a multicenter trial sponsored by the Eunice Kennedy Shriver National Institute of Kid Health and Human being Development, which included more than v,000 women 33. The 2017 Aspirin for Testify-Based Preeclampsia Prevention trial randomized ane,776 women at loftier risk of preeclampsia based on a starting time-trimester screening algorithm to 150-mg aspirin or placebo 39. The authors found a significant decrease in the rate of preterm preeclampsia (4.iii% versus i.6%; odds ratio, 0.38; 95% CI, 0.20–0.74). Although the 150-mg dose was used in this study, there are no available studies comparing lx–80 mg versus 150 mg. Further, the screening algorithm used includes first-trimester serum markers, including placental growth gene and pregnancy-associated plasma protein-A, too as uterine artery dopplers, which limits the generalizability to a U.S. population. Therefore, a higher dose or doubling of the available 81-mg dose cannot exist recommended at this time.

A meta-assay pooling individual patient data from 31 RCTs showed a modest issue of low-dose aspirin prophylaxis on prevention of preeclampsia in groups of women with various take chances profiles (RR, 0.90; 95% CI, 0.84–0.97) xiii. A subsequent Cochrane review, which pooled aggregate data from 59 trials, reported a 17% relative reduction in preeclampsia with low-dose aspirin utilise 12. All the same, 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 low-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, 13 of which reported preeclampsia incidence among women considered at highest risk of illness Table one 2. A 24% reduction in preeclampsia (RR, 0.76; CI, 0.62–0.95) with depression-dose aspirin prophylaxis (60–150 mg/day) was demonstrated 14. Nevertheless, the authors suggested this dramatic reduction in relative risk might be closer to 10% because of "pocket-sized study effects" of most of the included trials. Depending on baseline preeclampsia hazard, the relative hazard reduction with low-dose aspirin was associated with a small decrease in an absolute risk reduction of 2–5%.

Based on the findings from the USPSTF and others, low-dose aspirin prophylaxis (81 mg/day) afterwards 12 weeks of gestation modestly reduces the risk of preeclampsia in women at increased risk, without resulting in adverse fetal effects, increased maternal bleeding, or placental abruption. The recommendation to give low-dose aspirin prophylaxis to high-risk women is based on the number needed to care for in private adventure groups, which in plough is based on disease prevalence and treatment upshot. In low-take a chance groups (affliction prevalence of 2%), the number needed to treat is approximately 500, compared with a number needed to treat of 50 women in a high-risk group with a disease prevalence of 20%. The USPSTF guideline recommends giving depression-dose aspirin afterward 12 weeks of gestation to women with an absolute adventure of preeclampsia of at to the lowest degree eight%, the lowest incidence of preeclampsia in command groups of studies included in their review 2. Based on celebrated and demographic risk factors, the USPSTF guideline recommends that women with any of the loftier-risk factors for preeclampsia should receive low-dose aspirin prophylaxis. Low-dose aspirin prophylaxis should exist considered in women with more than one of several moderate run a risk factors for preeclampsia Table 1.

The American College of Obstetricians and Gynecologists and the Guild for Maternal-Fetal Medicine back up the USPSTF guideline criteria for prevention of preeclampsia. Low-dose aspirin (81 mg/24-hour interval) prophylaxis is recommended in women at high chance of preeclampsia and should exist initiated between 12 weeks and 28 weeks of gestation (optimally earlier 16 weeks) and connected daily until delivery. Women who were receiving medically-indicated low-dose aspirin for other established medical indications before 12–28 weeks may continue with low-dose aspirin handling.

Insufficient Prove for Low-Dose Aspirin

Stillbirth

Low-dose aspirin prophylaxis is not recommended for women with a history of stillbirth in the absenteeism of take a chance 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 too probable similar. Few studies have focused solely on the effect of low-dose aspirin prophylaxis on stillbirth. In one early nonrandomized trial, investigators reported a near twofold increase in live births when low-dose aspirin was given to women with at least one prior pregnancy loss at more than thirteen weeks of gestation and a negative result on antiphospholipid antibody testing xl. Findings were similar in a retrospective cohort study of 230 women with prior fetal loss at more than 10 weeks of gestation 41. However, the results of prospectively collected stillbirth data from RCTs and meta-analyses designed to written report the use of low-dose aspirin for preeclampsia prevention are inconclusive 12 xiii 14. Until additional supportive prove becomes available, depression-dose aspirin prophylaxis is not recommended solely for the indication of prior unexplained stillbirth in the absence of run a risk factors for preeclampsia.

Fetal Growth Restriction

Low-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 bereft evidence in women with an isolated history of fetal growth restriction. Still, in women at risk of preeclampsia, prophylaxis with low-dose aspirin (especially when initiated less than 16 weeks of gestation) may reduce the risk of fetal growth restriction. Abnormal placentation resulting in poor placental perfusion (ie, placental insufficiency) is the virtually common pathology associated with fetal growth brake 42. Some investigators take suggested that low-dose aspirin, initiated early in the beginning trimester, may prevent fetal growth restriction through its inhibitory activeness on platelet aggregation and improvement in placental development 43 44. 1 written report first reported that low-dose aspirin, in combination with dipyridamole, significantly reduced the incidence of recurrent fetal growth brake 45. Although this issue was confirmed in a subsequent meta-analysis, the study did not identify which women were most likely to benefit from low-dose aspirin 46. There are currently no well-powered RCTs evaluating the role of low-dose aspirin in the prevention of recurrent fetal growth restriction in otherwise low-risk women. Systematic reviews of low-dose aspirin when used in the setting of preeclampsia prevention accept consistently reported a x–20% reduction in fetal growth restriction or infants who were pocket-sized for gestational age 12 13 14 29 thirty 31 32. Prove every bit to whether starting depression-dose aspirin earlier 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 do good with before initiation 29 xxx 31 32. Currently, considering the majority 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 brake alone—at that place is insufficient evidence to support the employ of low-dose aspirin for fetal growth restriction prophylaxis in the absence of other risk factors for preeclampsia.

Preterm Birth

The effect of low-dose aspirin on preterm nascence as a master outcome remains understudied. However, until prove from high-quality studies directed towards prevention of spontaneous preterm birth go available, low-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 decrease uterine contractility past 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 furnishings of loftier-dose aspirin prohibit its utilise in the clinical setting. Low-dose aspirin has been reported to reduce preterm nascence (at less than 37 weeks of gestation) in 8–fourteen% of women at risk of preeclampsia 12 xiii 14 32. Even so, whether this reflects a reduction in medically indicated or spontaneous preterm births is not clear in about studies. A contempo systematic review and meta-analysis 48 analyzed private patient data from 17 trials of preeclampsia prevention (28,797 participants) that supplied sufficient detail regarding whether commitment was spontaneous or medically indicated. In that study, 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 14% reduction in spontaneous preterm birth 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 by 19%, but the departure was not statistically significant (RR, 0.81; 95% CI, 0.59–ane.ane) 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 low-dose aspirin, started before pregnancy and continued through pregnancy, was non associated with a reduction in overall preterm births (RR, 0.72; 95% CI, 0.42–1.23), spontaneous preterm nativity (RR, 0.51; 95% CI, 0.xix–1.34), or medically indicated preterm birth (RR, 0.89; 95% CI, 0.44–i.lxxx) 49.

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

Early on Pregnancy Loss

The combination of low-dose aspirin and unfractionated or depression-molecular-weight heparin has been shown to reduce the hazard of early on pregnancy loss in women with antiphospholipid syndrome 50. However, low-dose aspirin has not been shown to prevent unexplained early pregnancy loss in women who do not have antiphospholipid syndrome. Pooling data from ii trials (256 participants), one study reported no increase in alive births among women treated with low-dose aspirin compared with placebo (RR: 0.94, CI, 0.fourscore–1.eleven) 51. A 2014 study besides reported no difference in alive births when 1,078 women with one or ii prior pregnancy losses were given low-dose aspirin or placebo before pregnancy (58% versus 53%, P=.0984). Pregnancy loss occurred in 13% of 535 women given depression-dose aspirin compared with 12% of 543 women in the placebo grouping ( 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 depression-dose aspirin utilise in pregnancy is considered prophylactic and is associated with a low likelihood of serious maternal, or fetal complications, or both, related to use. The American Higher 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/d) prophylaxis is recommended in women at high risk of preeclampsia and should exist initiated between 12 weeks and 28 weeks of gestation (optimally before 16 weeks) and connected daily until commitment. Low-dose aspirin prophylaxis should be considered for women with more than than one of several moderate take a chance factors for preeclampsia. Women at risk of preeclampsia are defined based on the presence of one or more high-risk factors (history of preeclampsia, multifetal gestation, renal disease, autoimmune affliction, type one or type ii diabetes, and chronic hypertension) or more than than one moderate-chance factor (first pregnancy, maternal age of 35 years or older, a body mass alphabetize greater than thirty, family history of preeclampsia, sociodemographic characteristics, and personal history factors) Table i. In the absence of high-risk factors for preeclampsia, current testify does not back up the use of safety low-dose aspirin for the prevention of early on pregnancy loss, fetal growth restriction, stillbirth, or preterm nascency.

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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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