Perinatal & Pediatric
Low-dose aspirin prophylaxis for preeclampsia and the risk of postpartum cardiovascular outcomes: a propensity score analysis Ema Mujic* Ema Mujic Sojourna Ferguson Christina D. Yarrington Nyia Noel Samantha E. Parker
Background: The U.S Preventative Service Task Force recommends initiating low-dose aspirin (LDA) before 16 weeks of pregnancy to prevent developing preeclampsia among people with certain risk factors. While there are robust data supporting the effectiveness of LDA for the prevention of preeclampsia, limited data exist regarding its impact on postpartum outcomes.
Methods: We abstracted electronic medical record data on pregnant people who had a live birth from 2018-2019 and met criteria for LDA prophylaxis (n=1,862) at single safety-net hospital. We created propensity scores using major and moderate risk factors and prenatal care site and used 1:1 matching to identify unexposed (LDA-) matches for the 376 patients that received a prescription for LDA at ≤ 16 weeks of gestation (LDA+). Postpartum outcomes included anti-hypertensive use, postpartum hypertension and readmission. We calculated risk ratios (RR) and 95% confidence intervals (CI) for LDA and postpartum outcomes using log-binomial models. We also assessed the joint effect of LDA and preeclampsia on postpartum outcomes by calculating RRs for combinations of LDA and preeclampsia using those without either as the reference.
Results: After propensity score matching, our sample included 318 LDA+ and 318 LDA- patients with a similar distribution of preeclampsia risk factors. LDA+ was not associated with the postpartum outcomes examined in the overall cohort. However, in the presence of preeclampsia, LDA- patients had the highest risk of postpartum outcomes (e.g. hypertension; RR: 9.09; CI: 6.05, 13.65), while LDA+ patients saw an attenuation in risk (e.g. hypertension; RR: 6.77; CI:4.27, 10.74). (Figure)
Conclusion: Our findings suggest that LDA prescription does not decrease the risk of postpartum cardiovascular-related postpartum outcomes in diverse population of those at risk of preeclampsia. However, among those affected by preeclampsia, antepartum exposure to LDA may attenuate the risk of these outcomes.
