Download PDF
Am J Perinatol 2022; 39(06): 658-665
DOI: 10.1055/s-0040-1718581
Original Article

The Safety of Low-Dose Aspirin on the Mode of Delivery: Secondary Analysis of the Effect of Aspirin in Gestation and Reproduction Randomized Controlled Trial

Allison A. Eubanks 
1   Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland
,
Carrie J. Nobles
2   Division of Intramural Population Health Research, Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
,
Sunni L. Mumford
2   Division of Intramural Population Health Research, Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
,
Keewan Kim
2   Division of Intramural Population Health Research, Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
,
Micah J. Hill
3   Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
Alan H. Decherney
3   Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
Lindsey A. Sjaarda
2   Division of Intramural Population Health Research, Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
,
Aijun Ye
4   Glotech, Inc., Rockville, Maryland
,
Jeannie G. Radoc
2   Division of Intramural Population Health Research, Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
,
Neil J. Perkins
2   Division of Intramural Population Health Research, Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
,
Robert M. Silver
5   Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
,
Enrique F. Schisterman
2   Division of Intramural Population Health Research, Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
› Author Affiliations Funding This research was supported by the International Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (National Institutes of Health, Bethesda, MD, USA; contract numbers: HHSN267200603423, HHSN267200603424, and HHSN267200603426). J.G.R have been funded by the NIH Medical Research Scholars Program, a public–private partnership jointly supported by the NIH and generous contributions to the Foundation for the NIH by the Doris Duke Charitable Foundation (Grant no.: 2014194), the American Association for Dental Research, the Colgate Palmolive Company, Genentech, Elsevier and other private donors. For a complete list, visit the foundation website at http://www.fnih.org.
› Further Information
    Permissions and Reprints

Abstract

Objective This study aimed to examine whether prenatal low-dose aspirin (LDA) therapy affects risk of cesarean versus vaginal delivery.

Study Design This study is a secondary analysis of the randomized clinical effects of aspirin in gestation and reproduction (EAGeR) trial. Women received 81-mg daily aspirin or placebo from preconception to 36 weeks of gestation. Mode of delivery and obstetric complications were abstracted from records. Log-binomial regression models estimated relative risk (RR) of cesarean versus vaginal delivery. Data were analyzed among the total preconception cohort, as well as restricted to women who had a live birth.

Results Among 1,228 women, 597 had a live birth. In the intent-to-treat analysis, preconception-initiated LDA was not associated with risk of cesarean (RR = 1.02; 95% confidence interval [CI]: 0.98–1.07) compared with placebo. Findings were similar in just women with a live birth and when accounting prior cesarean delivery and parity.

Conclusion Preconception-initiated daily LDA was not associated with mode of delivery among women with one to two prior losses.

Key Points

  • Aspirin was not associated with risk of cesarean section.

  • Aspirin was not associated with mode of delivery.

  • No increased risk of bleeding with use of aspirin.

Keywords

low-dose aspirin - spontaneous vaginal delivery - cesarean delivery - induction - placentation

Note

The authors of this paper have no disclosures other than the advertised funding. The opinions expressed in this manuscript are those of the authors and do not represent the Department of Health and Human Services or the Department of Defense.


Supplementary Material



Publication History

Received: 14 May 2020

Accepted: 07 September 2020

Article published online:
19 October 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver national institute of child health and human development, society for maternal-fetal medicine, and American college of obstetricians and gynecologists workshop. Obstet Gynecol 2012; 120 (05) 1181-1193
    CrossrefPubMedGoogle Scholar
  • 2 American College of Obstetricians and Gynecologists. ACOG Practice bulletin no. 115: Vaginal birth after previous cesarean delivery. Obstet Gynecol 2010; 116 (2 Pt 1): 450-463
    CrossrefPubMedGoogle Scholar
  • 3 Curtin SC, Gregory KD, Korst LM, Uddin SF. Maternal morbidity for vaginal and cesarean deliveries, according to previous cesarean history: new data from the birth certificate, 2013. Natl Vital Stat Rep 2015; 64 (04) 1-13
    PubMedGoogle Scholar
  • 4 Dodd JM, Crowther CA, Huertas E, Guise JM, Horey D. Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth. Cochrane Database Syst Rev 2004; (04) CD004224
    PubMedGoogle Scholar
  • 5 Guise J-M, Eden K, Emeis C. et al. Vaginal birth after cesarean: new insights. Evid Rep Technol Assess (Full Rep) 2010; 191 (191) 1-397
    PubMedGoogle Scholar
  • 6 Edmonds JK, Yehezkel R, Liao X, Moore Simas TA. Racial and ethnic differences in primary, unscheduled cesarean deliveries among low-risk primiparous women at an academic medical center: a retrospective cohort study. BMC Pregnancy Childbirth 2013; 13 (01) 168
    CrossrefPubMedGoogle Scholar
  • 7 Henderson JT, O'Connor E, Whitlock EP. Low-dose aspirin for prevention of morbidity and mortality from preeclampsia. Ann Intern Med 2014; 161 (08) 613-614
    CrossrefPubMedGoogle Scholar
  • 8 Hauth JC, Goldenberg RL, Parker Jr CR. et al. Low-dose aspirin therapy to prevent preeclampsia. Am J Obstet Gynecol 1993; 168 (04) 1083-1091 , discussion 1091–1093
    CrossrefPubMedGoogle Scholar
  • 9 Rotchell YE, Cruickshank JK, Gay MP. et al. Barbados low dose aspirin study in pregnancy (BLASP): a randomised trial for the prevention of pre-eclampsia and its complications. Br J Obstet Gynaecol 1998; 105 (03) 286-292
    CrossrefPubMedGoogle Scholar
  • 10 Sibai BM, Caritis SN, Thom E. et al; The National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Prevention of preeclampsia with low-dose aspirin in healthy, nulliparous pregnant women. N Engl J Med 1993; 329 (17) 1213-1218
    CrossrefPubMedGoogle Scholar
  • 11 Subtil D, Goeusse P, Puech F. et al; Essai Régional Aspirine Mère-Enfant (ERASME) Collaborative Group. Aspirin (100 mg) used for prevention of pre-eclampsia in nulliparous women: the Essai Régional Aspirine Mère-Enfant study (Part 1). BJOG 2003; 110 (05) 475-484
    CrossrefPubMedGoogle Scholar
  • 12 LeFevre ML. U.S. Preventive Services Task Force. Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 161 (11) 819-826
    CrossrefPubMedGoogle Scholar
  • 13 Schisterman EF, Silver RM, Lesher LL. et al. Preconception low-dose aspirin and pregnancy outcomes: results from the EAGeR randomised trial. Lancet 2014; 384 (9937): 29-36
    CrossrefPubMedGoogle Scholar
  • 14 Schisterman EF, Silver RM, Perkins NJ. et al. A randomised trial to evaluate the effects of low-dose aspirin in gestation and reproduction: design and baseline characteristics. Paediatr Perinat Epidemiol 2013; 27 (06) 598-609
    CrossrefPubMedGoogle Scholar
  • 15 Mumford SL, Silver RM, Sjaarda LA. et al. Expanded findings from a randomized controlled trial of preconception low-dose aspirin and pregnancy loss. Hum Reprod 2016; 31 (03) 657-665
    CrossrefPubMedGoogle Scholar
  • 16 Roberge S, Bujold E, Nicolaides KH. Meta-analysis on the effect of aspirin use for prevention of preeclampsia on placental abruption and antepartum hemorrhage. Am J Obstet Gynecol 2018; 218 (05) 483-489
    CrossrefPubMedGoogle Scholar
  • 17 Moussa HN, Leon MG, Marti A. et al. Pregnancy outcomes in women with preeclampsia superimposed on chronic hypertension with and without severe features. Am J Perinatol 2017; 34 (04) 403-408
    PubMedGoogle Scholar
  • 18 Bujold E, Roberge S, Nicolaides KH. Low-dose aspirin for prevention of adverse outcomes related to abnormal placentation. Prenat Diagn 2014; 34 (07) 642-648
    CrossrefPubMedGoogle Scholar
  • 19 Mi MY, Collins JE, Lerner V, Losina E, Katz JN. Reliability of medical record abstraction by non-physicians for orthopedic research. BMC Musculoskelet Disord 2013; 14 (01) 181
    CrossrefPubMedGoogle Scholar
  • 20 Nahm Meredith. Data accuracy in medical record abstraction. Accessed September 21, 2020 at: https://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?referer=https://www.google.com/&httpsredir=1&article=1018&context=uthshis_dissertations#:~:text=articles%20and%20pooled.-,Our%20analysis%20demonstrates%20that%20the%20accuracy%20associated%20with%20data%20processing,5019%20errors%20per%2010%2C000%20fields)
    PubMedGoogle Scholar
  • 21 Ahrens KA, Silver RM, Mumford SL. et al. Complications and safety of preconception low-dose aspirin among women with prior pregnancy losses. Obstet Gynecol 2016; 127 (04) 689-698
    CrossrefPubMedGoogle Scholar
  • 22 Davies NJ. et al. Low-dose aspirin in the prevention of hypertensive disorders of pregnancy in relatively low-risk nulliparous women. Hypertens Pregnancy 1995; 14 (01) 49-55
    CrossrefPubMedGoogle Scholar
  • 23 Iriye BK, Gregory KD, Saade GR, Grobman WA, Brown HL. Quality measures in high-risk pregnancies: executive summary of a cooperative workshop of the Society for Maternal-Fetal Medicine, National Institute of Child Health and Human Development, and the American College of Obstetricians and Gynecologists. Am J Obstet Gynecol 2017; 217 (04) B2-B25
    CrossrefPubMedGoogle Scholar