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ORIGINAL PAPER
Does acetylsalicylic acid level the playing field? Low-dose aspirin and obstetric outcomes: a case-control study
 
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1
Jan Kochanowski University, Kielce, Poland
 
2
Provincial Combined Hospital, Kielce, Poland
 
 
Submission date: 2025-03-16
 
 
Final revision date: 2025-06-10
 
 
Acceptance date: 2025-07-13
 
 
Online publication date: 2026-03-16
 
 
Publication date: 2026-06-29
 
 
Corresponding author
Jakub Młodawski   

Collegium Medicum Jan Kochanowski University Kielce, Poland
 
 
Medical Studies 2026;42(2):224-229
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
The administration of low-dose acetylsalicylic acid (ASA) during pregnancy has been advocated to enhance obstetric outcomes, particularly in high-risk cases. While ASA is known to reduce certain complications, its broader impact on pregnancy outcomes remains under scrutiny. This study explores the effects of ASA on key obstetric and neonatal parameters in a clinical setting

Aim of the research:
This research aims to evaluate the influence of ASA use during pregnancy on preterm birth rates, neonatal Apgar scores, and neonatal intensive care unit (NICU) admissions, assessing whether ASA improves outcomes in high-risk pregnancies.

Material and methods:
A case-control study was conducted with 1644 pregnant individuals who underwent first-trimester screening and delivered at the Provincial Combined Hospital in Kielce. The case group comprised patients prescribed ASA, while the control group included those not using ASA. Outcomes such as preterm births (< 37 and < 35 weeks), Apgar scores at 1 and 10 minutes, and NICU admissions were compared. Statistical analyses, including odds ratios (ORs), assessed associations between ASA use and these outcomes

Results:
Out of the total cohort, 119 (10.22%) patients received low-dose acetylsalicylic acid (typically 150 mg). ASA users exhibited higher rates of preterm birth before 37 weeks of gestation (OR = 2.40), increased risk of neonatal intensive care unit (NICU) admission (OR = 2.23), and lower 1-minute Apgar scores (OR = 2.41); however, no significant differences were observed in Apgar scores at 10 minutes, and no differences were noted in the incidence of preterm birth before 35 weeks of gestation. Pre-existing conditions such as diabetes and hypertension were more prevalent among patients receiving ASA.

Conclusions:
These findings suggest that while low-dose ASA is widely used, it does not fully offset the elevated risk associated with high-risk pregnancies.
REFERENCES (20)
1.
Rolnik DL Wright D, Poon LC, O’Gorman N, Syngela- ki A, de Paco Matallana C, Akolekar R, Cicero S, Janga D, Singh M, Molina FS, Persico N, Jani JC, Plasencia W, Papaioannou G, Tenenbaum-Gavish K, Meiri H, Gizurarson S, Maclagan K, Nicolaides KH. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med. 2017; 377(7): 613-622.
 
2.
Stubert J, Hinz B, Berger R. The role of acetylsalicylic acid in the prevention of pre-eclampsia, fetal growth restriction, and preterm birth. Dtsch Arztebl Int. 2023; 120(37): 617-626.
 
3.
Ambati A Knight JS, Zuo Y. Antiphospholipid syndrome management: a 2023 update and practical algorithm-based approach. Curr Opin Rheumatol. 2023; 35(3): 149-160.
 
4.
Naimi AI, Perkins NJ, Sjaarda LA, Mumford SL, Platt RW, Silver RM, Schisterman EF. The effect of preconception-initiated low-dose aspirin on human chorionic gonadotropin-detected pregnancy, pregnancy loss, and live birth: per protocol analysis of a randomized trial. Ann Intern Med. 2021; 174(5): 595-601.
 
5.
Hoffman MK, Goudar SS, Kodkany BS, Metgud M, Somannavar M, Okitawutshu J, Lokangaka A, Tshefu A, Bose CL, Mwapule A, Mwenechanya M, Chomba E, Carlo WA, Chicuy J, Figueroa L, Garces A, Krebs NF, Jessani S, Zehra F, Saleem S, Goldenberg RL, Kurhe K, Das P, Patel A, Hibberd PL, Achieng E, Nyongesa P, Esamai F, Liechty EA, Goco N, Hemingway-Foday J, Moore J, Nolen TL, McClure EM, Koso-Thomas M, Miodovnik M, Silver R, Derman RJ; ASPIRIN Study Group. Low-dose aspirin for the prevention of preterm delivery in nulliparous women with a singleton pregnancy (ASPIRIN): a randomised, double-blind, placebo-controlled trial. Lancet. 2020; 395(10220): 285-293.
 
6.
Levin DL Mills LJ, Parkey M, Garriott J, Campbell W. Constriction of the fetal ductus arteriosus after administration of indomethacin to the pregnant Ewe. J Pediatr. 1979; 94: 647-650.
 
7.
Wyatt-Ashmead J. Antenatal closure of the ductus arteriosus and hydrops fetalis. Pediatr Dev Pathol. 2011; 14: 469-474.
 
8.
Poon LC, Shennan A, Hyett JA, Kapur A, Hadar E, Diva- kar H, McAuliffe F, da Silva Costa F, von Dadelszen P, McIntyre HD, Kihara AB, Di Renzo GC, Romero R, D’Alton M, Berghella V, Nicolaides KH, Hod M. The International Federation of Gynecology and Obstetrics initiative on pre-eclampsia: a pragmatic guide for first-trimester screening and prevention. Int J Gynaecol Obstet. 2019; 145 Suppl 1: 1-33.
 
9.
Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008; 61: 344-349.
 
10.
Rolnik DL, Wright D, Poon LC, O’Gorman N, Syngelaki A, de Paco Matallana C, Akolekar R, Cicero S, Janga D, Singh M, Molina FS, Persico N, Jani JC, Plasencia W, Papaioannou G, Tenenbaum-Gavish K, Meiri H, Gizurar- son S, Maclagan K, Nicolaides KH. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med. 2017; 377(7): 613-622.
 
11.
Roberge S, Bujold E, Nicolaides KH. Aspirin for the prevention of preterm and term preeclampsia: systematic review and metaanalysis. Am J Obstet Gynecol. 2018; 218(3): 287-293.
 
12.
Shen L, Martinez-Portilla RJ, Rolnik DL, Poon LC. ASPRE trial: risk factors for development of preterm pre-eclampsia despite aspirin prophylaxis. Ultrasound Obstet Gynecol. 2021; 58(4): 546-552.
 
13.
Mlodawski J, Mlodawska M, Pazera G, Michalski W, Domanski T, Dolecka-Slusarczyk M, Gluszek S, Rokita W. Cerebral palsy and obstetric-neonatological interventions. Ginekol Pol. 2019; 90(12): 722-727.
 
14.
Zheng SL, Roddick AJ. Association of aspirin use for primary prevention with cardiovascular events and bleeding events: a systematic review and meta-analysis. JAMA. 2019; 321(3): 277-287.
 
15.
Xu TT, Zhou F, Deng CY, Huang GQ, Li JK, Wang XD. Low-dose aspirin for preventing preeclampsia and its complications: a meta-analysis. J Clin Hypertens (Greenwich). 2015; 17(7): 567-573.
 
16.
Lin X, Yong J, Gan M, Tang S, Du J. Impact of low-dose aspirin exposure on obstetrical outcomes: a meta-analysis. J Psychosom Obstet Gynaecol. 2024; 45(1): 2344079.
 
17.
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(5): 483-489.
 
18.
Vinogradov R, Boag C, Murphy P, McGeeney D, Kunadian V, Robson SC. Aspirin non-response in pregnant women at increased risk of pre-eclampsia. Eur J Obstet Gynecol Reprod Biol. 2020; 254: 292-297.
 
19.
Olson DN, Russell T, Ranzini AC. Assessment of adherence to aspirin for preeclampsia prophylaxis and reasons for nonadherence. Am J Obstet Gynecol. 2022; 4(5): 100663.
 
20.
Ayala DE, Ucieda R, Hermida RC. Chronotherapy with low-dose aspirin for prevention of complications in pregnancy. Chronobiol Int. 2012; 30: 260-279.
 
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ISSN:1899-1874
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