Friday, November 4, 2016

Aspirin in Pregnancy

  • Indication: Preeclampsia
  • Dose: 75mg/day
Product Leaflet :
  • Aspirin should not be used in pregnancy as it may be associated with prolongation of labour and with maternal and neonatal bleeding.
Lexicomp :
  • Salicylates do cross placenta.
  • Use of aspirin close to delivery may cause premature closure of the ductus arteriosus.
  • Low dose may be used to prevent preeclampsia in women with history of early-onset preeclampsia and preterm delivery, or preeclampsia in more than 1 prior pregnancy.
  • Low dose aspirin is used to treat complications resulting from antiphospholipid syndrome in pregnancy (either primary or secondary to SLE)
  • Low dose aspirin to prevent thrombosis may also be used during the second and third trimesters in women with prosthetic valves (mechanical or bio prosthetic).
  • The use of warfarin is recommended, along with low dose aspirin, in those with mechanical valves.
  • In general, low doses during pregnancy needed for the treatment of certain medical conditions have not been shown to cause fetal harm: however, discontinuing therapy prior to delivery is recommended.
Drugs.com:
  • Aspirin has not been formally assigned to pregnancy category by the FDA. However, aspirin is considered to be in pregnancy category D by the FDA if full dose aspirin is taken in the third trimester.
  • High doses have been associated with increased perinatal mortality, intrauterine growth retardation, and teratogenic effects.
  • FDA issued a warning that it is especially important not to use aspirin during the last trimester of pregnancy unless specifically directed to do so by a physician because it may cause problems in the unborn child or complications during delivery.
  • Increased maternal bleeding can occur during delivery when aspirin is used 1 week prior to and/or during labor and delivery. Prolonged gestation and labor have been reported due to aspirin's inhibition of prostaglandin.
  • Low dose aspirin in pregnancy is safe with respect to the risks of malformation and of major impairment in development at 18 months of age
US Preventive Services:
  • Pregnant Women Who Are At High Risk for Preeclampsia: The USPSTF recommends the use of low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of gestation in women who are at high risk for preeclampsia.
WHO Guidelines
Antiplatelets for Prevention of Pre-eclampsia:
  • Low-dose acetylsalicylic acid (aspirin, 75 mg/day) is recommended for the prevention of pre-eclampsia in women at high risk of developing the condition. (Moderate-quality evidence, Strong recommendation)
  • Low-dose acetylsalicylic acid (aspirin, 75 mg/day) for the prevention of pre-eclampsia and its related complications should be initiated before 20 weeks of pregnancy. (Low-quality evidence, Weak recommendation)

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