A JEYARUBAN1, R SHANMUGALINGAM1,2,3,4,P WU1, R CAO1, V WONG4,5,T WONG3,4,6, J FLACK3,4,6, A MAKRIS1,2,3,4
1Department of Renal Medicine, Liverpool Hospital, SWSLHD, Sydney, Australia, 2Women’s Health Initiative Translational Research Unit (WHITU), Ingham Institute, SWSLHD, Sydney, Australia, 3School of Medicine, Western Sydney University, Sydney, Australia, 4South Western Sydney Clinical School), University of New South Wales, Sydney, Australia, 5Department of Endocrinology, Liverpool Hospital SWSLHD, Sydney, Australia, 6Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, SWSLHD, Sydney, Australia
Aim: To investigate the influence of prophylactic aspirin on obstetric outcomes in women with PGDM.
Background: Women with pre-gestational diabetes mellitus (PGDM) are at an increased risk of preeclampsia. Initiation of prophylactic aspirin prior to 16 weeks of gestation in these women has been shown to reduce their risk of preeclampsia.
Method: A retrospective audit of data from pregnant women with PGDM from 2 centres in South-Western Sydney from January 2005 to June 2020 was conducted. Data were obtained from a district-wide electronic database and hospital medical records. The outcomes examined were preeclampsia, preterm delivery (less than 37 weeks) and newborn birth weight. Early preeclampsia was defined as less than 34 weeks and late preeclampsia was defined as 34 weeks or greater.
Results: Of 494 women 52(11%) women were prescribed prophylactic aspirin before 16 weeks of gestation. Women who were prescribed aspirin before 16 weeks of gestation were more likely to be taking calcium but did not otherwise significantly differ compared to women not taking aspirin. Preeclampsia developed in 57(12%) women and was early-onset preeclampsia in 24(5%) women. In the women prescribed aspirin, 8(15%) women developed preeclampsia compared to 49(11%) in those not prescribed aspirin (p=0.2). Furthermore, aspirin use was not significantly associated with a difference in birth weight percentile (57 vs 63,p=0.2). However, higher number of preterm deliveries (21(41%) vs 97(23%),p<0.05) was observed in women who were prescribed aspirin. This was also observed post adjustment for age, primigravida and other comorbidities.
Conclusion: This study demonstrated a higher rate of preterm delivery in women with pre-gestational diabetes who were prescribed aspirin. There was no difference in the rate of preeclampsia and newborn birth weight.
Andrew Jeyaruban is a second year renal advanced trainee at Liverpool Hospital. He graduated from James Cook University and then did his training at Royal Brisbane hospital and Liverpool hospital. He has special interest in renal genetics, renal supportive care and obstetric medicine.