Association between aspirin use during pregnancy and cardiovascular risk factors 2–7 years after delivery: The nuMoM2b Heart Health Study
Introduction
Women with adverse pregnancy outcomes, including hypertensive disorders of pregnancy, stillbirth, preterm birth, and delivery of a small-for-gestational age neonate, have higher risk for the subsequent development of cardiovascular disease compared to women with normal pregnancy outcomes [1], [2], [3], [4], [5], [6], [7]. While the pathophysiologic mechanisms underlying this association remain poorly understood, low-dose aspirin has been investigated as a preventive therapy for both placenta-mediated pregnancy complications (mostly hypertensive disorders of pregnancy) [8], [9] and cardiovascular disease outside of pregnancy [10]. Even at low doses, aspirin achieves irreversible inhibition of cyclooxygenase enzymes, reducing platelet activation, production of thromboxane A2, and subsequent platelet aggregation [11], [12]. These processes have been implicated in the pathogenesis of both abnormal placentation [13] and cardiovascular events such as myocardial infarction and stroke [14].
Large multinational randomized trials of low-dose aspirin during pregnancy have demonstrated meaningful reductions in the risk for preeclampsia among women assigned to aspirin therapy [8], [9]. In addition, low-dose aspirin has been associated with a decreased risk for perinatal death, preterm birth, and delivery of a small-for-gestational age neonate [15], [16], [17], [18]. The United States Preventive Services Task Force (USPSTF) now recommends daily low-dose (81 mg) aspirin for the prevention of preeclampsia among women with risk factors [19]. Numerous studies have assessed the effect of aspirin on pregnancy outcomes, and other studies have assessed the association between pregnancy outcomes and later cardiovascular health. However, the relationship between aspirin use in pregnancy and subsequent cardiovascular risk trajectory is unknown.
We hypothesize that aspirin use during the first pregnancy confers cardiovascular protection beyond the first pregnancy. We aimed to determine whether women who took aspirin during their first pregnancy have more favorable cardiovascular risk profiles several years after delivery compared to women who did not take aspirin, adjusting for propensity for aspirin use.
Section snippets
Methods
This is a secondary analysis of the Nulliparous Pregnancy Outcomes Study – Monitoring Mothers-to-be (nuMoM2b) Heart Health Study (HHS). The nuMoM2b-HHS is a prospective observational cohort that followed participants for 2–7 years following their first pregnancy to investigate relationships between adverse pregnancy outcomes and cardiovascular health [20]. Participants were enrolled in nuMoM2b during the first trimester of their first pregnancy and completed an in-person nuMoM2b-HHS study visit
Results
After excluding 4 participants with missing data regarding aspirin exposure, we included 4,480 women who had completed medication forms during their first pregnancy and subsequently attended an in-person nuMoM2b-HHS study visit (Fig. 1). Eighty-four women (1.9% of the study population) reported taking aspirin during their first pregnancy. Compared with women who did not take aspirin during their first pregnancy, women who reported taking aspirin were older, had higher education levels, private
Discussion
In this secondary analysis of the nuMoM2b-HHS prospective cohort, exposure to aspirin during the first pregnancy was not associated with cardiovascular events or diagnoses 2–7 years after delivery. Although not statistically significant, it is worth noting that the point estimate for the association between aspirin exposure and incident chronic kidney disease 2–7 years later was in the positive direction (toward aspirin exposure being associated with chronic kidney disease). This may reflect
Funding sources
This work was supported by cooperative agreement funding from the National Heart, Lung, and Blood Institute and the Eunice Kennedy Shriver National Institute of Child Health and Human Development: U10‐HL119991; U10‐HL119989; U10‐HL120034; U10‐HL119990; U10‐HL120006; U10‐HL119992; U10‐HL120019; U10‐HL119993; U10‐HL120018, and U01HL145358. The study was also supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development: U10 HD063036; U10
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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For better care we need better data: towards a national obstetrics registry
2023, American Journal of Obstetrics and Gynecology MFMCitation Excerpt :Prospective data collection performed in multicenter settings allows customization of the data collection process to obtain detailed, purpose-driven data. An example of a successful, large multicenter obstetrical study is the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b), one of many studies facilitated through the Maternal-Fetal Medicine Units network.23 The advantages of multicenter prospective studies include extraordinarily detailed and standardized data collection with abstraction by trained study personnel and correlation with biospecimen collection.