Key result
Implementation of universal prophylactic aspirin for pregnant women with diabetes did not reduce the prevalence of preeclampsia compared with risk-based prophylaxis (12% vs. 11%, P=0.69).
Why the study?
To evaluate whether implementing prophylactic aspirin for all pregnant women with preexisting diabetes changes the prevalence of preeclampsia compared with a previous risk-based approach.
Does universal prophylactic aspirin reduce the prevalence of preeclampsia in pregnant women with preexisting diabetes compared to risk-based prophylaxis?
Cohort (n=410)
Does universal prophylactic aspirin reduce the prevalence of preeclampsia in pregnant women with preexisting diabetes compared to risk-based prophylaxis?
Absolute Event Rate: 12% vs 11%
p-value: p=0.69
Universal aspirin prophylaxis for all pregnant women with preexisting diabetes did not reduce the prevalence of preeclampsia compared to a risk-based approach.
Universal aspirin did not reduce preeclampsia prevalence in this cohort; leaves open whether routine prophylaxis benefits diabetes pregnancies, warranting RCTs.
OBJECTIVE To evaluate the prevalence of preeclampsia after implementation of prophylactic aspirin for all pregnant women with preexisting diabetes compared with the prevalence in a previous risk-based prophylaxis. RESEARCH DESIGN AND METHODS A prospective observational cohort study of 410 consecutive pregnant women with preexisting diabetes categorized according to aspirin prophylaxis strategy, with the prevalence of preeclampsia as primary outcome. In total, 207 women were included after implementation of prophylactic aspirin for all pregnant women with preexisting diabetes in February 2018 (all-cohort). The 203 women included before this date, where aspirin prophylaxis was risk based and only prescribed to selected women (selected-cohort), were studied for comparison. RESULTS Aspirin was prescribed at ∼10 gestational weeks for 88% (all-cohort) compared with 25% (selected-cohort). HbA1c, parity, chronic hypertension, home blood pressure, microalbuminuria/diabetic nephropathy, and smoking were similar in the two cohorts in early pregnancy. In the all-cohort, fewer women had type 2 diabetes (32% vs. 42%, respectively; P = 0.04) and BMI tended to be lower (P = 0.05). The prevalence of preeclampsia was similar (12% vs. 11%, P = 0.69) in the two cohorts, and this was also the case with stratification for diabetes type. Prevalence of preterm delivery <37 weeks (23% vs. 27%, P = 0.30), preterm preeclampsia (7% vs. 7%, P = 0.96), and infants large (40% vs. 32%, P = 0.07) and small (7% vs. 6%, P = 0.88) for gestational age was similar in the two cohorts. CONCLUSIONS Implementation of prophylactic aspirin for all pregnant women with diabetes did not reduce the prevalence of preeclampsia compared with the previous risk-based prophylaxis in this cohort study.
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Vestgaard et al. (2021) conducted a cohort in pregnant women with preexisting diabetes (n=410). Universal prophylactic aspirin vs. Risk-based aspirin prophylaxis was evaluated on prevalence of preeclampsia (p=0.69). Implementation of universal prophylactic aspirin for pregnant women with diabetes did not reduce the prevalence of preeclampsia compared with risk-based prophylaxis (12% vs. 11%, P=0.69).
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