DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20201229

Effect of low dose aspirin on maternal outcome in women at risk for developing pregnancy induced hypertension

Madhusmita Pradhan, Kishore S. V., Jyotiranjan Champatiray

Abstract


Background: Pre-eclampsia is not totally a preventable disease. It is found more related to chains of social ills such as poor maternal nutrition, limited or no antenatal care and poor reproductive education. However, some specific “high-risk” factors leading to pregnancy induced hypertension (PIH) may be identified in individuals which include and not limited to young and elderly primigravida, multiple pregnancy, diabetes, Rh incompatibility, new paternity, pre-existing vascular or renal disease, family history of hypertension, pre-eclampsia and eclampsia, obesity, thrombophilia. Low dose aspirin given in 2nd trimester in these high-risk women is anticipated to prevent the development of PIH.

Methods: This prospective randomized controlled trial was conducted in the department of obstetrics and gynecology, SCB MC and Hospital, Cuttack during November 2018 to October 2019. Pregnant women between the gestational age of 13th to 28th weeks were screened for risk factors and included in this study. Low dose aspirin of 60 mg daily till delivery was given to pregnant women who consented to be a part of study randomly with the other group having placebo.

Results: Protienuric hypertension was high in control group who did not receive aspirin. Low dose aspirin significantly reduces PIH in high-risk group (3.48% in case versus 23.52% in control). Low dose aspirin was not associated with significant increase in placental bleeding. Low dose aspirin was generally safe for the fetus and new born infant with no evidence of an increased likelihood of bleeding.

Conclusions: Low dose aspirin has a definite role in the prevention of PIH in high risk pregnancy. Low dose aspirin reduces the incidence of PIH. Low dose aspirin can be considered a safe drug without any deleterious side effect for mother and the fetus. Benefits of prevention of PIH, justifies its administration in women at high risk.


Keywords


Aspirin, High risk pregnancy, Pre-eclampsia, Thromboxane

Full Text:

PDF

References


Osungbade KO, Ige OK. Public health perspectives of preeclampsia in developing countries: implication for health system strengthening. J Preg. 2011;2011:481095.

Rao KB. Report of maternal mortality committee, Federation of obstetrics and gynecology. Soci India. 1982:12.

Montgomery AL, Ram U, Kumar R, Jha P. Million death study collaborators. Maternal mortality in India: causes and healthcare service use based on a nationally representative survey. PLoS One. 2014;9(1):e83331.

Redman CWG. Current topic: pre-eclampsia and the placenta. Placenta. 1991;12:301-8.

Henderson JT, Whitlock EP, O'Connor E, Senger CA, Thompson JH, Rowland MG. Low-dose aspirin for the prevention of morbidity and mortality from preeclampsia: a systematic evidence review for the U.S. preventive services task force. Evide Synth. 2014;14-05207-EF-1.

Aguayo Víctor M, Kajali P. Nutrition in adolescent girls in South Asia. BMJ. 2017;357:j1309.

International Institute for Population Sciences. National family health surveys, India. Key findings from NFHS-3. Mumbai: International Institute for Population Sciences; 2007. Available at: http://rchiips.org/nfhs/factsheet.shtml. Accessed 13 January 2020.

Mukhopadhyay P, Chaudhuri RN, Paul B. Hospital-based perinatal outcomes and complications in teenage pregnancy in India. J Health Popul Nutr. 2010;28(5):494-500.

Britto, Catherin, Nisha. Awareness of Government Maternity Benefit Schemes among women attending antenatal clinic in a rural hospital in Karnataka, India. Inter J Current Res Acad Rev. 2015;3:137-43.

Dairo, Magbagbeola, Owoyokun, Kunle. Factors affecting the utilization of antenatal care services in Ibadan, Nigeria. Nigeria Benin J Postgrad Med. 2010;12:1.

Hernández-Díaz S, Toh S, Cnattingius S. Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study. BMJ. 2009;338:b2255.

Bangal VB, Giri PA, Mahajan AS. Maternal and foetal outcome in pregnancy induced hypertension: a study from rural tertiary care teaching hospital in India. Int J Biomed Res. 2011;2:595-9.

Rastogi A, National Health Portal published in 2016, Govt. of India. Available at: https://www.nhp.gov.in/disease/gynaecology-and-obstetrics/preeclampsia. Accessed on 13th January 2020.

Ramaiya C, Mgaya HN. Low dose aspirin in prevention of pregnancy-induced hypertension in primigravidae at the Muhimbili Medical Center, Dar es Salaam. East Afr Med J. 1995;72:690-3.

CLASP: A randomised trial of low-dose aspirin for the prevention and treatment of pre-eclampsia among 9364 pregnant women. CLASP (Collaborative Low-dose Aspirin Study in Pregnancy) Collaborative Group. Lancet. 1994;343:619-29.

Cheng WW, Zhang ZJ. Low-dose aspirin preventing pregnancy induced hypertension (in Chinese) Zhonghua Fu Chan Ke Za Zhi. 1991;26:342-5.

Imperiale TF, Petrulis AS. A meta-analysis of low-dose aspirin for the prevention of pregnancy-induced hypertensive disease. JAMA. 1991;266(2):260-4.

Rogers MS, Fung HY, Hung CY. Calcium and low-dose aspirin prophylaxis in women at high risk of pregnancy-induced hypertension. Hypertens Preg. 1999;18:165-72.