LOW-DOSE ASPIRIN TO IMPROVE PERINATAL OUTCOME

The list of clinical conditions for which aspirin may produce abatement or reversal of pathologic processes continues to be expanded. There are, however, definite risks reported from the use of aspirin during pregnancy, even though some of the findings have been contradictory. Some of the potential adverse effects on the infant also remain unclear. Potential benefits from the use of low doses of aspirin during pregnancy (although promising) are still experimental. Large clinical trials in the United States and overseas are currently assessing the effectiveness of low-dose aspirin in preventing preeclampsia and fetal growth retardation. A review of the world's literature to date describes over 300 pregnancies in which low-dose aspirin has been used with no evidence of major adverse effects. Until more conclusive evidence emerges, however, caution against the indiscriminate use of aspirin in any dose during pregnancy is urged. Clinicians who decide to manage complicated or potentially complicated patients with chronic administration of aspirin must continue to study these mothers, fetuses, and neonates intensively and to document their results. Because of the fear of teratogenic effects in the first trimester, initiation of aspirin therapy should be withheld until the 13th week of gestation. However, current data indicates it can be continued until delivery without complication. Monitoring of these patients should include: warning signs and symptoms of bleeding, serial ultrasonography for fetal growth and fluid, serial fetal echocardiography, and neonatal evaluation for bleeding complications. Such clinical experience will add immensely to our understanding of the safety and efficacy of aspirin during pregnancy.