LDA safety in pregnancy

June 10, 2024

Issue 12

Clinical Question

Does low-dose aspirin increase risk of IBD relapse in pregnant patients?

Editor’s Bottom Line

These data provide reassurance for pregnant women with IBD who may benefit from low-dose ASA for prevention of preeclampsia.

Reference

DeBolt CA, Gottlieb ZS, Rao MG, et al. Low-Dose Aspirin Use Does Not Increase Disease Activity in Pregnant Patients with Inflammatory Bowel Disease. Dig Dis Sci. 2024;69(5):1803–07. https://link.springer.com/article

Synopsis

Researchers at Mount Sinai Hospital, New York set out to determine the safety of low-dose aspirin (LDA) in pregnant patients with IBD, as LDA is recommended for women at increased risk of developing preeclampsia.

To that end, they retrospectively reviewed data from 384 pregnant adults with IBD who had delivered a singleton, non-anomalous neonate between 2012 and 2020. Of these individuals, 18.5% were receiving LDA during pregnancy.

Authors analyzed demographic and clinical data and defined active ulcerative colitis as a partial Mayo score ≥2 and active Crohn’s disease as a Harvey Bradshaw Index score ≥5. In cases where these indices were not documented, hospital admissions, outpatient clinic visits for IBD symptoms or claims indicating IBD treatment escalation were used as surrogates for increased disease activity. The researchers also compared levels of C-reactive protein and fecal calprotectin throughout the study in LDA and non-LDA users.

Between 94% of LDA and non-LDA users had well-controlled disease at the time of conception and clinical remission rates remained similar throughout pregnancy in the two groups. Analyses found there were no significant associations between higher levels of C-reactive protein and fecal calprotectin and LDA use.

Those using LDA were slightly older than those who did not use LDA (mean 35 vs. 33; p=0.003) and were more likely to have chronic hypertension (10% vs. 1.6%; p=0.002) and to have used in vitro fertilization to achieve pregnancy (24.3% vs. 7.7%; p=0.03). Patients receiving LDA were also more likely to be receiving a biologic to manage IBD (49.3% vs. 35.8%; p=0.03)

Details

Study Design: Retrospective cohort
Funding: None
Allocation: Not applicable
Setting: center
Level of Evidence: 2b