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Clinical Obstetrics

Poster Session 4

(1091) The effect of aspirin treatment on obstetric complications in twin gestations in a retrospective cohort

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective: Pregnant persons with twin gestations are at increased risk for obstetric complications including preeclampsia, gestational hypertension, gestational diabetes, and preterm birth. Low dose aspirin (ASA) has been shown to decrease rates of preeclampsia in singleton pregnancies and recent studies suggest the benefits of ASA may extend beyond preeclampsia. We aimed to evaluate if ASA use reduces preeclampsia or other obstetric complications in twin gestations.

Study Design: Planned secondary analysis of a 17-center, retrospective cohort of twin pregnancies aimed to study cell-free DNA screening performance. The primary exposure was ASA use at cell-free DNA blood draw. The primary outcome was preeclampsia. Secondary outcomes included preeclampsia< 34 weeks, preeclampsia with severe features, preterm birth, spontaneous preterm birth, fetal death and gestational diabetes. Those with unknown ASA use status, unknown chorionicity, and vanishing twins were excluded. Baseline characteristics and obstetric outcomes were compared amongst pregnancies taking vs not taking ASA. Outcomes were further analyzed using logistic regression.

Results:

Of the 1335 included subjects twin gestations, 320 took ASA and 1015 did not take ASA. Demographic and medical differences existed between the groups (Table 1). There was no difference in preeclampsia < 34 weeks, preeclampsia with severe features, preterm birth, fetal death, and gestational diabetes with respect to ASA exposure. There was a higher risk of preeclampsia in those who took ASA, however after adjustment for BMI, race, pre-gestational diabetes, cHTN and preeclampsia in a prior pregnancy, this association was no longer significant (RR 1.36 95% CI 1.04-1.77; aRR 1.11 95% CI 0.81-1.54).

Conclusion: In this cohort, prophylactic ASA did not significantly decrease risk for preeclampsia or spontaneous preterm birth.  This information may prove to be helpful in counseling; additional prospective studies are indicated regarding ASA indications and benefits.