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Based on historic and demographic vosol factors, the USPSTF guideline recommends that women with any of the high-risk factors for preeclampsia should receive low-dose aspirin prophylaxis. Low-dose aspirin prophylaxis should be considered in women with more than one of several moderate risk factors Brimonidine Topical Gel (Mirvaso)- Multum preeclampsia Table 1. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine support the USPSTF guideline criteria for prevention of preeclampsia.

Low-dose aspirin prophylaxis is not recommended for women with a history of stillbirth in the absence of risk factors for preeclampsia. Few studies have focused solely on the effect of low-dose aspirin prophylaxis on stillbirth.

In one designer nonrandomized trial, investigators reported a nearly twofold increase in live births when low-dose aspirin was given to women with at least one prior pregnancy loss at more than 13 weeks of gestation and a negative result on antiphospholipid antibody testing 40.

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 study the use of low-dose aspirin for preeclampsia prevention are inconclusive 12 13 14. Until additional supportive evidence becomes available, low-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 for prevention of recurrent fetal growth restriction is similarly not currently recommended in women without other risk factors for preeclampsia because of insufficient evidence in women with an isolated history of fetal growth restriction.

However, in women at risk Brimonidine Topical Gel (Mirvaso)- Multum preeclampsia, prophylaxis with low-dose aspirin (particularly when down less than 16 weeks of gestation) may reduce the risk of fetal growth restriction. Danocrine (Danazol)- Multum placentation resulting in poor placental perfusion (ie, placental insufficiency) is the most common pathology associated with fetal growth restriction 42.

Some investigators have suggested that low-dose aspirin, initiated early in the first trimester, may prevent fetal growth restriction through its inhibitory action on platelet aggregation and improvement in placental development 43 44.

One study first reported that low-dose aspirin, in combination with dipyridamole, significantly reduced the incidence Brimonidine Topical Gel (Mirvaso)- Multum recurrent fetal growth restriction 45. Although this outcome 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. Evidence as to whether starting low-dose aspirin before 16 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 30 31 32.

Currently, because 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 preeclampsianot Brimonidine Topical Gel (Mirvaso)- Multum histories of fetal growth restriction alonethere is insufficient evidence to support the use of low-dose aspirin for fetal growth restriction prophylaxis in the absence of other risk factors for preeclampsia.

The effect of low-dose aspirin on preterm birth as a primary outcome remains Bekyree (Desogestrel and Ethinyl Estradiol Tablets)- FDA. However, until evidence from high-quality studies directed towards prevention of spontaneous preterm birth become 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 by inhibiting COX-dependent prostaglandin synthesis 47. High doses of aspirin have been studied Brimonidine Topical Gel (Mirvaso)- Multum treat preterm labor, but the irreversible binding to COX-2 and adverse maternal and fetal effects of high-dose aspirin prohibit its use in the clinical setting. 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-analysis 48 analyzed individual patient data from 17 trials of preeclampsia prevention (28,797 participants) that supplied sufficient detail regarding whether delivery was spontaneous or medically indicated. 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 not associated with a reduction in overall preterm births (RR, 0.

The combination of low-dose aspirin and unfractionated or low-molecular-weight heparin has been shown to reduce the risk of early 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 obesity morbid two trials (256 participants), one study reported no increase in live births among women treated with low-dose aspirin compared with placebo (RR: 0.

Based on the available evidence, the use of low-dose aspirin prophylaxis is not recommended for the prevention of early pregnancy loss. 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 disease, type Brimonidine Topical Gel (Mirvaso)- Multum or type 2 diabetes, Brimonidine Topical Gel (Mirvaso)- Multum chronic hypertension) or more than one moderate-risk factor (first pregnancy, maternal age of 35 years or older, a body mass index greater than 30, family history of preeclampsia, Brimonidine Topical Gel (Mirvaso)- Multum characteristics, and personal history Brimonidine Topical Gel (Mirvaso)- Multum Table 1.

In the absence of high-risk factors for preeclampsia, current evidence does not support the use of prophylactic low-dose aspirin for the prevention of early pregnancy loss, fetal growth restriction, stillbirth, or preterm birth.

This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care.

It is not intended to substitute for the independent professional judgment of the treating clinician. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, Brimonidine Topical Gel (Mirvaso)- Multum of available resources, or advances in knowledge or technology.

Any updates to this document can be found on www. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person.



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