Preventing adverse outcomes in ART-related twin pregnancies using aspirin

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In a previous study published recently Scientific reportResearchers in China investigated the efficacy of low-dose aspirin (LDA) in reducing adverse pregnancy outcomes in a particular case of twins conceived through assisted reproductive technology (ART).

They found that while LDA can effectively prevent preeclampsia (PE) without significant risk of bleeding, it cannot prevent certain complications in twin pregnancies, with a more pronounced preventive effect in mothers younger than 30 years.

Study: Potential effect of aspirin use as primary prevention of adverse pregnancy outcomes in twins conceived using ART.  Image credit: fizkes/Shutterstock.comStudy: Potential impact of aspirin use as primary prevention on adverse pregnancy outcomes in twins conceived using ART. Image credit: fizkes/Shutterstock.com

Background

Despite advances in ART since 1978, perinatal outcomes in ART pregnancies fail to surpass unassisted pregnancies. The increased use of ART has led to an increase in twin pregnancies, leading to various complications in management.

More than 50% of twins experience preterm labor (PTL) compared to singletons, with a significantly higher risk of PE and cesarean delivery. In addition, the emotional burden on multiple mothers and those undergoing ART is notable for higher expectations of better outcomes.

Evidence suggests that LDA use before 16 weeks of gestation may help reduce the risk of PE and small-for-gestational-age (SGA) neonates.

Despite a randomized trial showing a lower incidence of preterm birth with aspirin use, concern exists about the risk of possible postpartum bleeding.

Limited studies have investigated the efficacy of LDA in twin pregnancies, particularly from ART. Therefore, the researchers in the present study aimed to evaluate whether LDA improves pregnancy outcomes in ART-associated twin pregnancies.

Studytop is about form

The present retrospective cohort study included 665 women aged 18–55 years with twin pregnancies on ART between 2016 and 2021. Inclusion criteria included twins diagnosed by ultrasound before 16 weeks.

Prenatal, delivery-related, and neonatal health data were obtained from standardized electronic records. Women with no prenatal health records and those with a history of use of selective serotonin reuptake inhibitors or low-molecular-weight heparin were excluded. At final follow-up there were 510 participants – 257 in the control group and 253 in the LDA group.

Obstetricians applied different principles of aspirin use in twin pregnancies from ART, considering the limited evidence of aspirin safety in this context and randomly assigned 100 mg/day aspirin at the first prenatal visit (10–16 gestational weeks) to the LDA group.

Primary findings of the study focused on pregnancy complications, including common problems such as gestational age at delivery, PE, hypertensive disorders, gestational diabetes, premature rupture of membranes, placental abruption, placenta accreta, intrahepatic cholestasis of pregnancy (ICP), abnormal thyroid. Function, abnormal amniotic fluid and mode of delivery.

Secondary outcomes were twin-specific complications, such as SGA, selective intrauterine growth restriction, twin reverse arterial perfusion sequence, twin-to-twin transfusion syndrome, stillbirth, and miscarriage.

The safety of aspirin was evaluated based on postpartum hemorrhage, uterine artery embolization, transfusion, and transfer to the ICU (short for intensive care unit). At the same time, birth-related characteristics included sex ratio, birth weight, and NICU (short for neonatal ICU) transfer.

Pregnancy complications and adverse outcomes were defined based on specific criteria in line with international practice recommendations. Statistical analysis involves determining the mean and standard deviation and using the chi-square test, students t-test, and Fisher’s exact test.

Results and discussion

The population consisted of 476 dichorionic and 34 monozygotic twins, of whom 500 were conceived through IVF-ET (abbreviated in vitro fertilization and embryo transfer) and through 10 IUI (short for intrauterine insemination).

During this 6-year-long study, an increasing trend of twin pregnancies from ART was observed, in addition to an increasing trend of aspirin use in this group. Comparisons between aspirin users and non-users reveal different effects on pregnancy complications.

Although overall hypertensive disorders were higher in aspirin users (p < 0.05), PE incidence was found to be lower in this population (p < 0.05).

Aspirin use did not significantly affect gestational age at delivery, nor was it found to increase the risk of bleeding. Moreover, the cesarean section rate was significantly lower in the aspirin group.

Neonatal outcomes showed no significant differences except for gender. Aspirin use also did not appear to reduce their NICU admissions.

Detailed analysis of mothers and age stratification revealed a potentially more pronounced protective effect of aspirin on adverse outcomes in mothers younger than 30 years.

Conclusion

Overall, this novel study provides insight into the complex relationship between aspirin use and maternal and neonatal outcomes in twin pregnancies from ART.

LDA initiation at an early gestational age significantly reduces the risk of PE without increasing serious bleeding-related complications.

These findings encourage health care professionals to weigh the pros and cons of using LDA in specific cases to improve pregnancy outcomes while ensuring safety.



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