Does acetylsalicylic acid level the playing field? Low-dose aspirin and obstetric outcomes: a case-control study

Introduction
The administration of low-dose acetylsalicylic acid (ASA) during pregnancy has been advocated to enhance obstetric outcomes, particularly in high-risk cases. While ASA is known to reduce certain complications, its broader impact on pregnancy outcomes remains under scrutiny. This study explores the effects of ASA on key obstetric and neonatal parameters in a clinical setting. Aim of the research: This research aims to evaluate the influence of ASA use during pregnancy on preterm birth rates, neonatal Apgar scores, and neonatal intensive care unit (NICU) admissions, assessing whether ASA improves outcomes in high-risk pregnancies.

Material and methods
A case-control study was conducted with 1644 pregnant individuals who underwent first-trimester screening and delivered at the Provincial Combined Hospital in Kielce. The case group comprised patients prescribed ASA, while the control group included those not using ASA. Outcomes such as preterm births (< 37 and < 35 weeks), Apgar scores at 1 and 10 minutes, and NICU admissions were compared. Statistical analyses, including odds ratios (ORs), assessed associations between ASA use and these outcomes.

Results
Out of the total cohort, 119 (10.22%) patients received low-dose acetylsalicylic acid (typically 150 mg). ASA users exhibited higher rates of preterm birth before 37 weeks of gestation (OR = 2.40), increased risk of neonatal intensive care unit (NICU) admission (OR = 2.23), and lower 1-minute Apgar scores (OR = 2.41); however, no significant differences were observed in Apgar scores at 10 minutes, and no differences were noted in the incidence of preterm birth before 35 weeks of gestation. Pre-existing conditions such as diabetes and hypertension were more prevalent among patients receiving ASA.

Conclusions
These findings suggest that while low-dose ASA is widely used, it does not fully offset the elevated risk associated with high-risk pregnancies.