Impact of low-dose acetylsalicylic acid on pregnancy outcome in systemic lupus erythematosus: results from a multicentre study

Abstract

ObjectiveIt is still a matter of debate whether low-dose acetylsalicylic acid (LDASA) should be prescribed to all patients with SLE during pregnancy. This study aimed at investigating the impact of LDASA on pregnancy outcomes in patients with SLE without history of renal involvement and without antiphospholipid antibodies (aPL).MethodsThis is a retrospective analysis of prospectively monitored pregnancies at seven rheumatology centres. Previous/current renal involvement and aPL positivity were the exclusion criteria. Adverse pregnancy outcome (APO) is the composite outcome of the study and included proteinuric pre-eclampsia, preterm delivery <37 weeks, small-for-gestational age infant, low birth weight <2500 g, intrauterine growth restriction and intrauterine fetal death after 12 weeks of gestation of a morphologically normal fetus.Results216 pregnancies in 187 patients were included; 82 pregnancies (38.0%) were exposed to LDASA treatment. No differences in terms of age at conception, disease duration, clinical manifestations, comorbidities and disease flare during pregnancy were observed between patients taking LDASA and those who did not take LDASA during pregnancy. APO was observed in 65 cases (30.1%), including 13 cases (6.1%) of pre-eclampsia. The incidence of all complications was similar in the two groups. However, it is interesting to note that pre-eclampsia had lower frequency in patients taking LDASA versus those not taking LDASA (2.4% vs 8.3%, p=0.14).ConclusionsIn pregnant patients with SLE without renal involvement and were aPL-negative, there is a low risk of severe obstetric complications, such as early pre-eclampsia. LDASA treatment does not provide a statistically significant advantage over these complications. However, a careful individual risk–benefit balance is warranted.

Preparing for Pregnancy in Women with Systemic Lupus Erythematosus—A Multidisciplinary Approach

“…EULAR recommends LDA in SLE pregnant women especially if they have a history of lupus nephritis or are positive for APLA (5). This indication is supported by the results of a multicentre study published in 2022 that evaluated the impact of LDA on pregnancy outcomes in SLE women [ 52 ]. ACR suggests that treatment with LDA should be considered for all pregnant women with SLE [ 15 ].…”

Systemic lupus erythematosus: one year in review 2023

“…• Pathogenic changes in the placentas are described in SLE patients (87), and GCs appear to induce the expression of ITGA8 on amnion mesenchymal cells, triggering pre-term premature rupture of membranes (88). • Low-dose acetylsalicylic acid treatment during pregnancy was not found to be protective against obstetric complications in SLE patients without aPL or history of renal involvement (90).…”

“…With regards to treatment during pregnancy, it is still a matter of debate whether low-dose acetylsalicylic acid (LDASA) should be prescribed to all patients with SLE during pregnancy. A multicentre study(90) has investigated the impact of LDASA on pregnancy outcomes in patients with SLE with no history of renal involvement and or aPL. The incidence of APO was similar in pregnancy exposed and not exposed to LDASA.…”

Benefits of Hydroxychloroquine Combined with Low-Dose Aspirin on Pregnancy Outcomes and Serum Cytokines in Pregnant Women with Systemic Lupus Erythematosus

“…Aspirin, a cyclooxygenase (COX)-1) inhibitor, can adjust the balance of platelets, thromboxane A2 (TAX2), and prostacyclin to reduce platelet activation, promote vasodilation, improve placental blood supply, prevent microthrombosis, and reduce adverse pregnancy outcomes and obstetric complications [ 9 ]. The protective effect of low-dose acetylsalicylic acid (LDASA) in pre-eclampsia has been demonstrated in non-autoimmune, high-risk obstetric patients and patients with SLE with prior renal involvement and/or antiphospholipid antibodies (aPL) [ 23 ]. In pregnant patients with SLE without renal involvement, and who were aPL-negative, there is a low risk of severe obstetric complications, such as early pre-eclampsia.…”

“…In pregnant patients with SLE without renal involvement, and who were aPL-negative, there is a low risk of severe obstetric complications, such as early pre-eclampsia. LDASA treatment does not provide a statistically significant advantage over these complications [ 23 ]. The 2020 ACR Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases suggests treatment with LDASA in all pregnant women with SLE [ 24 ].…”