Key result
Aspirin use prior to 16 weeks in pregnant women with pre-existing diabetes showed no difference in pre-eclampsia (OR 0.9; 95% CI 0.3-3.0; P=0.924) despite a higher baseline risk.
Why the study?
Aspirin is routinely prescribed in high-risk pregnancies to prevent pre-eclampsia, but data are scarce in women with pre-existing diabetes.
Does aspirin prevent pre-eclampsia in pregnant women with pre-existing diabetes?
Cohort (n=164)
No
Does aspirin prevent pre-eclampsia in pregnant women with pre-existing diabetes?
Odds Ratio: 0.9 (95% CI 0.3–3)
p-value: p=0.924
In women with pre-existing diabetes, early aspirin use did not significantly reduce pre-eclampsia but was associated with an increased risk of postpartum hemorrhage, though interpretation is limited by baseline risk differences.
Aspirin showed no pre-eclampsia reduction yet higher postpartum haemorrhage risk in pre-existing diabetes; leaves open efficacy and safety pending randomized data.
BACKGROUND: Aspirin is routinely prescribed in high-risk pregnancies to prevent pre-eclampsia; however, there is a paucity of data in women with pre-existing diabetes. AIMS: To assess the efficacy and safety of aspirin in women with pre-existing diabetes in preventing pre-eclampsia. METHODS: A retrospective review of women with pre-existing diabetes who attended antenatal clinics in a tertiary referral hospital between 2013 and 2019 was conducted. Cases were those receiving aspirin prior to 16 weeks, with pre-eclampsia as the primary outcome. The relationship between early pregnancy glycaemic control and pre-eclampsia was also assessed. RESULTS: Of the 164 women included in the study, 45 received aspirin. There were no differences in pre-eclampsia (odds ratio (OR) 0.9 (0.3-3.0), P = 0.924) or any other measure of placental insufficiency (OR 1.7 (0.7-4.3), P = 0.243) between the aspirin and control groups after adjusting for baseline differences. Aspirin therapy was associated with an increased risk of postpartum haemorrhage (PPH) (OR 3.1 (1.1-9.1), P = 0.041). The incidence of pre-eclampsia increased stepwise according to early pregnancy HbA1c subgroups of ≤6.0% (n = 47), 6.1-7.5% (n = 57) and > 7.5% (n = 39), with rates of 0, 12.3 and 20.5% (P = 0.007) respectively. CONCLUSIONS: The aspirin group had a higher baseline risk of pre-eclampsia and placental insufficiency, therefore the absence of difference between the groups favoured the efficacy of aspirin. PPH was highlighted as a potential complication of therapy, and early pregnancy HbA1c as a novel risk stratification tool for pre-eclampsia in women with pre-existing diabetes.
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Lah et al. (2021) conducted a cohort in Pre-existing diabetes in pregnancy (n=164). Aspirin prior to 16 weeks vs. Control (no aspirin) was evaluated on Pre-eclampsia (OR 0.9, 95% CI 0.3-3.0, p=0.924). Aspirin use prior to 16 weeks in pregnant women with pre-existing diabetes showed no difference in pre-eclampsia (OR 0.9; 95% CI 0.3-3.0; P=0.924) despite a higher baseline risk.
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