Low Dose Aspirin in Pregnancy



Canberra Hospital and Health Services

Clinical Guideline

Low Dose Aspirin in Pregnancy

|Contents |

Contents 1

Guideline Statement 2

Scope 2

Section 1 – High risk factors for developing pre-eclampsia in pregnancy 2

Section 2 – Moderate risk factors for developing pre-eclampsia in pregnancy 2

Section 3 – Recommended aspirin use 3

References 3

Search Terms 4

|Guideline Statement |

Background

Hypertensive disorders are one of the leading causes of direct maternal death in Australia (2008-2012). The National Institute for Health and Clinical Excellence (NICE) recommends women at high risk of pre-eclampsia should take aspirin daily.

Key Objective

This document will assist staff in identifying those high-risk women who have one or more high risk factors for developing pre-eclampsia in pregnancy and therefore should be treated with Aspirin.

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|Scope |

This document applies to the following Canberra Hospital Health Services (CHHS) staff working within their scope of practice:

• Medical Officers

• Registered Nurses and Midwives

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|Section 1 – High risk factors for developing pre-eclampsia in pregnancy |

High risk factors for developing pre-eclampsia in pregnancy include:

• Hypertensive disease during a previous pregnancy

• chronic kidney disease

• autoimmune disease such as systemic lupus erythematosis or antiphospholipid syndrome

• type 1 or type 2 diabetes

• chronic hypertension

• pregnancy-associated plasma protein A (PAPP-A) ≤0.4 Multiple of Means (MoMs)

• Previous fetal growth restriction.

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|Section 2 – Moderate risk factors for developing pre-eclampsia in pregnancy |

Moderate risk factors for developing pre-eclampsia in pregnancy include:

• First pregnancy

• age 40 years or older

• pregnancy interval of more than 10 years

• body mass index (BMI) of 35 kg/m2 or more at first visit

• family history of pre-eclampsia

• multiple pregnancy.

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|Section 3 – Recommended aspirin use |

Aspirin is recommended for all women who have one or more high risk factors for developing pre-eclampsia in pregnancy or who are deemed high risk on 1st trimester screening

Women with two or more moderate risk factors will be assessed by the medical officer and a decision for aspirin use made on an individual basis.

As per current evidence, women at increased risk of pre-eclampsia should take 150mg of aspirin daily at night from confirmation of a viable intra-uterine pregnancy (8-10 weeks) or as early as possible in 2nd trimester before 16 weeks, until at 34 – 36 weeks.

Contraindications include an allergy to aspirin or NSAIDS and aspirin sensitive asthma. Relative contraindications include: a history of a previous GIT bleed, severe hepatic dysfunction, peptic ulcer disease or nasal polyps.

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|References |

1. National Institute of Health and Clinical Excellence. Hypertension in Pregnancy CG107, NICE: London, 2010

2. AIHW: Humphrey MD, Bonello MR, Chughtai A, Macaldowie A, Harris K & Chambers GM 2015. Maternal deaths in Australia 2008–2012. Maternal deaths series no. 5. Cat. no. PER 70. Canberra: AIHW.

3. Daniel L. Rolnik, M.D., David Wright, Ph.D., Liona C. Poon, M.D., Neil O’Gorman, M.D., Argyro Syngelaki, Ph.D., Catalina de Paco Matallana, M.D., Ranjit Akolekar, M.D., Simona Cicero, M.D., Deepa Janga, M.D., Mandeep Singh, M.D., Francisca S. Molina, M.D., Nicola Persico, M.D., Jacques C. Jani, M.D., Walter Plasencia, M.D., George Papaioannou, M.D., Kinneret Tenenbaum-Gavish, M.D., Hamutal Meiri, Ph.D., Sveinbjorn Gizurarson, Ph.D., Kate Maclagan, Ph.D., and Kypros H. Nicolaides, M.D. (2017) Asprin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med 2017; 377:613-622

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|Search Terms |

Pre-eclampsia, Hypertensive disorders of pregnancy, Aspirin, Aspirin in pregnancy

Disclaimer: This document has been developed by Health Directorate, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

|Date Amended |Section Amended |Approved By |

|Eg: 17 August 2014 |Section 1 |ED/CHHSPC Chair |

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