Advertisement
Systematic Review| Volume 5, ISSUE 4, 100878, April 2023

Download started.

Ok

Low-dose asprin use during pregnancy may be a potential risk for postpartum hemorrhage and increased blood loss: a systematic review and meta-analysis

  • Yi Jiang
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (Dr Jiang, Dr Wei, Dr Gao, Dr Zhang, Dr Zhou, Dr Zhu, Dr H Zhang, Dr Du, Miss Fang, Miss Su, Dr Wang, Dr Yu, Dr He, Dr Ding, and Dr Feng)
    Search for articles by this author
  • Zhuoru Chen
    Affiliations
    Children's Hospital of Fudan University, Shanghai, China (Miss Chen)
    Search for articles by this author
  • Yuting Chen
    Affiliations
    Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China (Dr Chen)
    Search for articles by this author
  • Lijie Wei
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (Dr Jiang, Dr Wei, Dr Gao, Dr Zhang, Dr Zhou, Dr Zhu, Dr H Zhang, Dr Du, Miss Fang, Miss Su, Dr Wang, Dr Yu, Dr He, Dr Ding, and Dr Feng)
    Search for articles by this author
  • Peng Gao
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (Dr Jiang, Dr Wei, Dr Gao, Dr Zhang, Dr Zhou, Dr Zhu, Dr H Zhang, Dr Du, Miss Fang, Miss Su, Dr Wang, Dr Yu, Dr He, Dr Ding, and Dr Feng)
    Search for articles by this author
  • Jingyi Zhang
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (Dr Jiang, Dr Wei, Dr Gao, Dr Zhang, Dr Zhou, Dr Zhu, Dr H Zhang, Dr Du, Miss Fang, Miss Su, Dr Wang, Dr Yu, Dr He, Dr Ding, and Dr Feng)
    Search for articles by this author
  • Xuan Zhou
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (Dr Jiang, Dr Wei, Dr Gao, Dr Zhang, Dr Zhou, Dr Zhu, Dr H Zhang, Dr Du, Miss Fang, Miss Su, Dr Wang, Dr Yu, Dr He, Dr Ding, and Dr Feng)
    Search for articles by this author
  • Shenglan Zhu
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (Dr Jiang, Dr Wei, Dr Gao, Dr Zhang, Dr Zhou, Dr Zhu, Dr H Zhang, Dr Du, Miss Fang, Miss Su, Dr Wang, Dr Yu, Dr He, Dr Ding, and Dr Feng)
    Search for articles by this author
  • Huiting Zhang
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (Dr Jiang, Dr Wei, Dr Gao, Dr Zhang, Dr Zhou, Dr Zhu, Dr H Zhang, Dr Du, Miss Fang, Miss Su, Dr Wang, Dr Yu, Dr He, Dr Ding, and Dr Feng)
    Search for articles by this author
  • Yuanyuan Du
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (Dr Jiang, Dr Wei, Dr Gao, Dr Zhang, Dr Zhou, Dr Zhu, Dr H Zhang, Dr Du, Miss Fang, Miss Su, Dr Wang, Dr Yu, Dr He, Dr Ding, and Dr Feng)
    Search for articles by this author
  • Chenyun Fang
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (Dr Jiang, Dr Wei, Dr Gao, Dr Zhang, Dr Zhou, Dr Zhu, Dr H Zhang, Dr Du, Miss Fang, Miss Su, Dr Wang, Dr Yu, Dr He, Dr Ding, and Dr Feng)
    Search for articles by this author
  • Rui Su
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (Dr Jiang, Dr Wei, Dr Gao, Dr Zhang, Dr Zhou, Dr Zhu, Dr H Zhang, Dr Du, Miss Fang, Miss Su, Dr Wang, Dr Yu, Dr He, Dr Ding, and Dr Feng)
    Search for articles by this author
  • Shaoshuai Wang
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (Dr Jiang, Dr Wei, Dr Gao, Dr Zhang, Dr Zhou, Dr Zhu, Dr H Zhang, Dr Du, Miss Fang, Miss Su, Dr Wang, Dr Yu, Dr He, Dr Ding, and Dr Feng)
    Search for articles by this author
  • Jun Yu
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (Dr Jiang, Dr Wei, Dr Gao, Dr Zhang, Dr Zhou, Dr Zhu, Dr H Zhang, Dr Du, Miss Fang, Miss Su, Dr Wang, Dr Yu, Dr He, Dr Ding, and Dr Feng)
    Search for articles by this author
  • Mengzhou He
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (Dr Jiang, Dr Wei, Dr Gao, Dr Zhang, Dr Zhou, Dr Zhu, Dr H Zhang, Dr Du, Miss Fang, Miss Su, Dr Wang, Dr Yu, Dr He, Dr Ding, and Dr Feng)
    Search for articles by this author
  • Wencheng Ding
    Correspondence
    Corresponding authors: Wencheng Ding, PhD and Ling Feng, PhD.
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (Dr Jiang, Dr Wei, Dr Gao, Dr Zhang, Dr Zhou, Dr Zhu, Dr H Zhang, Dr Du, Miss Fang, Miss Su, Dr Wang, Dr Yu, Dr He, Dr Ding, and Dr Feng)
    Search for articles by this author
  • Ling Feng
    Correspondence
    Corresponding authors: Wencheng Ding, PhD and Ling Feng, PhD.
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (Dr Jiang, Dr Wei, Dr Gao, Dr Zhang, Dr Zhou, Dr Zhu, Dr H Zhang, Dr Du, Miss Fang, Miss Su, Dr Wang, Dr Yu, Dr He, Dr Ding, and Dr Feng)
    Search for articles by this author
Published:January 24, 2023DOI:https://doi.org/10.1016/j.ajogmf.2023.100878

      OBJECTIVE

      The association between aspirin use during pregnancy and the risk of postpartum hemorrhage remains unclear. This study aimed to explore the incidence of postpartum hemorrhage and the amount of postpartum blood loss among women who used aspirin during pregnancy.

      DATA SOURCES

      From inception to October 2022, this study searched the following databases: MEDLINE, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials.

      STUDY ELIGIBILITY CRITERIA

      Studies comparing pregnancy outcomes that covered the incidence of postpartum hemorrhage or the amount of postpartum blood loss in pregnancies with aspirin vs placebo (or no aspirin) were included.

      METHODS

      Reviewers separately ascertained studies, obtained data, and gauged study quality. The meta-analysis was conducted using a random effects model owing to the probable heterogeneity of the included studies. The rates of postpartum hemorrhage or the mean amounts of postpartum blood loss were compared, and the odds ratios or mean differences with 95% confidence intervals were estimated. Of note, 2 parts performed both a pooled analysis of randomized controlled trials and cohort studies and a separate analysis of randomized controlled trials.

      RESULTS

      Overall, 21 studies with 373,926 women were included in the postpartum hemorrhage part, and 7 studies with 10,163 women were included in the postpartum blood loss part. The results suggested that aspirin (dose 60-150mg a day) use during pregnancy was associated with an increased incidence of postpartum hemorrhage (odds ratio, 1.20; 95% confidence interval, 1.07–1.34). When only randomized controlled trials were retained, the results remained significant (odds ratio, 1.12; 95% confidence interval, 1.00–1.25). In the second part, higher total blood loss after delivery was obtained (mean difference, 12.85 mL; 95% confidence interval, 3.28–22.42), and the result was unaltered when cohort studies were eliminated (mean difference, 13.72 mL; 95% confidence interval, 4.63–22.81). The conclusions are more likely to be obtained in developed countries.

      CONCLUSION

      Low-dose aspirin use during pregnancy is a potential risk of postpartum hemorrhage and does slightly increase the amount of postpartum blood loss. Without denying the combined value of aspirin, our conclusions raised an alarm for clinicians about postpartum hemorrhage in women using aspirin during pregnancy.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology MFM
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Say L
        • Chou D
        • Gemmill A
        • et al.
        Global causes of maternal death: a WHO systematic analysis.
        Lancet Glob Health. 2014; 2 (e323–33)
        • Bienstock JL
        • Eke AC
        • Hueppchen NA.
        Postpartum hemorrhage.
        N Engl J Med. 2021; 384: 1635-1645
        • Committee on Practice Bulletins-Obstetrics
        Practice Bulletin No. 183: postpartum hemorrhage.
        Obstet Gynecol. 2017; 130 (e168–86)
        • Giouleka S
        • Tsakiridis I
        • Kalogiannidis I
        • et al.
        Postpartum hemorrhage: a comprehensive review of guidelines.
        Obstet Gynecol Surv. 2022; 77: 665-682
        • Meher S.
        How should we diagnose and assess the severity of PPH in clinical trials?.
        Best Pract Res Clin Obstet Gynaecol. 2019; 61: 41-54
      1. Quantitative blood loss in obstetric hemorrhage: ACOG Committee Opinion, Number 794.
        Obstet Gynecol. 2019; 134: e150-e156
        • Dahlke JD
        • Mendez-Figueroa H
        • Maggio L
        • et al.
        Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines.
        Am J Obstet Gynecol. 2015; 213 (76.e1–10)
        • Vane JR
        • Botting RM.
        The mechanism of action of aspirin.
        Thromb Res. 2003; 110: 255-258
        • Toth L
        • Muszbek L
        • Komaromi I.
        Mechanism of the irreversible inhibition of human cyclooxygenase-1 by aspirin as predicted by QM/MM calculations.
        J Mol Graph Model. 2013; 40: 99-109
        • Atallah A
        • Lecarpentier E
        • Goffinet F
        • Doret-Dion M
        • Gaucherand P
        • Tsatsaris V.
        Aspirin for prevention of preeclampsia.
        Drugs. 2017; 77: 1819-1831
        • Hoffman MK
        • Goudar SS
        • Kodkany BS
        • et al.
        Low-dose aspirin for the prevention of preterm delivery in nulliparous women with a singleton pregnancy (ASPIRIN): a randomised, double-blind, placebo-controlled trial.
        Lancet. 2020; 395: 285-293
        • Roberge S
        • Nicolaides K
        • Demers S
        • Hyett J
        • Chaillet N
        • Bujold E.
        The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis.
        Am J Obstet Gynecol. 2017; 216 (110–120.e6)
        • Rolnik DL
        • Wright D
        • Poon LC
        • et al.
        Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia.
        N Engl J Med. 2017; 377: 613-622
        • Sibai BM
        • Caritis SN
        • Thom E
        • et al.
        Prevention of preeclampsia with low-dose aspirin in healthy, nulliparous pregnant women. The National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units.
        N Engl J Med. 1993; 329: 1213-1218
        • Preventive Services Task Force US
        • Davidson KW
        • Barry MJ
        • et al.
        Aspirin use to prevent preeclampsia and related morbidity and mortality: US Preventive Services Task Force Recommendation Statement.
        JAMA. 2021; 326: 1186-1191
        • Abdelaziz HK
        • Saad M
        • Pothineni NVK
        • et al.
        Aspirin for primary prevention of cardiovascular events.
        J Am Coll Cardiol. 2019; 73: 2915-2929
        • Mahady SE
        • Margolis KL
        • Chan A
        • et al.
        Major GI bleeding in older persons using aspirin: incidence and risk factors in the ASPREE randomised controlled trial.
        Gut. 2021; 70: 717-724
        • Basson MD
        • Panzini L
        • Palmer RH.
        Effect of nabumetone and aspirin on colonic mucosal bleeding time.
        Aliment Pharmacol Ther. 2001; 15: 539-542
        • Johnston SC
        • Amarenco P
        • Aunes M
        • et al.
        Ischemic benefit and hemorrhage risk of ticagrelor-aspirin versus aspirin in patients with acute ischemic stroke or transient ischemic attack.
        Stroke. 2021; 52: 3482-3489
        • Hastie R
        • Tong S
        • Wikstrom AK
        • Sandström A
        • Hesselman S
        • Bergman L.
        Aspirin use during pregnancy and the risk of bleeding complications: a Swedish population-based cohort study.
        Am J Obstet Gynecol. 2021; 224 (95.e1–12)
        • Gu W
        • Lin J
        • Hou YY
        • et al.
        Effects of low-dose aspirin on the prevention of preeclampsia and pregnancy outcomes: a randomized controlled trial from Shanghai, China.
        Eur J Obstet Gynecol Reprod Biol. 2020; 248: 156-163
        • Zheng SL
        • Roddick AJ.
        Association of aspirin use for primary prevention with cardiovascular events and bleeding events: a systematic review and meta-analysis.
        JAMA. 2019; 321: 277-287
        • Roberge S
        • Bujold E
        • Nicolaides KH.
        Meta-analysis on the effect of aspirin use for prevention of preeclampsia on placental abruption and antepartum hemorrhage.
        Am J Obstet Gynecol. 2018; 218: 483-489
        • Page MJ
        • McKenzie JE
        • Bossuyt PM
        • et al.
        The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
        BMJ. 2021; 372: n71
        • Sterne JAC
        • Savovic J
        • Page MJ
        • et al.
        RoB 2: a revised tool for assessing risk of bias in randomised trials.
        BMJ. 2019; 366: l4898
      2. Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2021. Available at: https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed November 15, 2020.

        • Balduzzi S
        • Rucker G
        • Schwarzer G.
        How to perform a meta-analysis with R: a practical tutorial.
        Evid Based Ment Health. 2019; 22: 153-160
      3. CLASP: a randomised trial of low-dose aspirin for the prevention and treatment of pre-eclampsia among 9364 pregnant women. CLASP (Collaborative Low-dose Aspirin Study in Pregnancy) Collaborative Group.
        Lancet. 1994; 343: 619-629
      4. ECPPA: randomised trial of low dose aspirin for the prevention of maternal and fetal complications in high risk pregnant women. ECPPA (Estudo Colaborativo para Prevencao da Pre-eclampsia com Aspirina) Collaborative Group.
        Br J Obstet Gynaecol. 1996; 103: 39-47
        • Byaruhanga RN
        • Chipato T
        • Rusakaniko S.
        A randomized controlled trial of low-dose aspirin in women at risk from pre-eclampsia.
        Int J Gynaecol Obstet. 1998; 60: 129-135
        • Caritis S
        • Sibai B
        • Hauth J
        • et al.
        Low-dose aspirin to prevent preeclampsia in women at high risk. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units.
        N Engl J Med. 1998; 338: 701-705
        • Golding J.
        A randomised trial of low dose aspirin for primiparae in pregnancy. The Jamaica Low Dose Aspirin Study Group.
        Br J Obstet Gynaecol. 1998; 105: 293-299
        • Rotchell YE
        • Cruickshank JK
        • Gay MP
        • et al.
        Barbados Low Dose Aspirin Study in Pregnancy (BLASP): a randomised trial for the prevention of pre-eclampsia and its complications.
        Br J Obstet Gynaecol. 1998; 105: 286-292
        • Subtil D
        • Goeusse P
        • Puech F
        • et al.
        Aspirin (100 mg) used for prevention of pre-eclampsia in nulliparous women: the Essai Regional Aspirine Mere-Enfant study (Part 1).
        BJOG. 2003; 110: 475-484
        • Yu CK
        • Papageorghiou AT
        • Parra M
        • Palma Dias R
        • Nicolaides KH
        • Fetal Medicine Foundation Second Trimester Screening Group
        Randomized controlled trial using low-dose aspirin in the prevention of pre-eclampsia in women with abnormal uterine artery Doppler at 23 weeks’ gestation.
        Ultrasound Obstet Gynecol. 2003; 22: 233-239
        • Bakhti A
        • Vaiman D.
        Prevention of gravidic endothelial hypertension by aspirin treatment administered from the 8th week of gestation.
        Hypertens Res. 2011; 34: 1116-1120
        • Ayala DE
        • Ucieda R
        • Hermida RC.
        Chronotherapy with low-dose aspirin for prevention of complications in pregnancy.
        Chronobiol Int. 2013; 30: 260-279
        • Scazzocchio E
        • Oros D
        • Diaz D
        • et al.
        Impact of aspirin on trophoblastic invasion in women with abnormal uterine artery Doppler at 11-14 weeks: a randomized controlled study.
        Ultrasound Obstet Gynecol. 2017; 49: 435-441
        • Mone F
        • Mulcahy C
        • McParland P
        • et al.
        Trial of feasibility and acceptability of routine low-dose aspirin versus Early Screening Test indicated aspirin for pre-eclampsia prevention (TEST study): a multicentre randomised controlled trial.
        BMJ Open. 2018; 8e022056
        • Sharma N
        • Srinivasan S
        • Srinivasan KJ
        • Nadhamuni K.
        Role of aspirin in high pulsatility index of uterine artery: a consort study.
        J Obstet Gynaecol India. 2018; 68: 382-388
        • Lah S
        • Cheung NW
        • Lee V
        • Athayde N
        • Inglis E
        • Padmanabhan S.
        Aspirin and pre-eclampsia prevention in women with pre-existing diabetes: a retrospective study.
        Intern Med J. 2021; 51: 1673-1680
        • Ye Y
        • Wen L
        • Liu X
        • et al.
        Low-dose aspirin for primary prevention of adverse pregnancy outcomes in twin pregnancies: an observational cohort study based on propensity score matching.
        BMC Pregnancy Childbirth. 2021; 21: 786
        • Landman AJEMC
        • de Boer MA
        • Visser L
        • et al.
        Evaluation of low-dose aspirin in the prevention of recurrent spontaneous preterm labour (the APRIL study): a multicentre, randomised, double-blinded, placebo-controlled trial.
        PLoS Med. 2022; 19e1003892
        • Lin L
        • Huai J
        • Li B
        • et al.
        A randomized controlled trial of low-dose aspirin for the prevention of preeclampsia in women at high risk in China.
        Am J Obstet Gynecol. 2022; 226 (251.e1–12)
        • White K
        • Son M
        • Lundsberg LS
        • et al.
        Low dose aspirin for preeclampsia prevention and postpartum blood loss.
        Am J Obstet Gynecol. 2022; (S75–6)
      5. Low-dose aspirin in prevention and treatment of intrauterine growth retardation and pregnancy-induced hypertension. Italian study of aspirin in pregnancy.
        Lancet. 1993; 341: 396-400
        • Ritter JM
        • Farquhar C
        • Rodin A
        • Thom MH.
        Low dose aspirin treatment in late pregnancy differentially inhibits cyclo-oxygenase in maternal platelets.
        Prostaglandins. 1987; 34: 717-722
        • Kyle PM
        • Buckley D
        • Kissane J
        • de Swiet M
        • Redman CW.
        The angiotensin sensitivity test and low-dose aspirin are ineffective methods to predict and prevent hypertensive disorders in nulliparous pregnancy.
        Am J Obstet Gynecol. 1995; 173: 865-872
        • Haapsamo M
        • Martikainen H
        • Tinkanen H
        • Heinonen S
        • Nuojua-Huttunen S
        • Räsänen J.
        Low-dose aspirin therapy and hypertensive pregnancy complications in unselected IVF and ICSI patients: a randomized, placebo-controlled, double-blind study.
        Hum Reprod. 2010; 25: 2972-2977
        • Ende HB
        • Lozada MJ
        • Chestnut DH
        • et al.
        Risk factors for atonic postpartum hemorrhage: a systematic review and meta-analysis.
        Obstet Gynecol. 2021; 137: 305-323
        • Erazo-Martinez V
        • Nieto-Aristizabal I
        • Ojeda I
        • et al.
        Systemic erythematosus lupus and pregnancy outcomes in a Colombian cohort.
        Lupus. 2021; 30: 2310-2317
        • Yip KC
        • Luo Z
        • Huang X
        • et al.
        The role of aspirin dose and initiation time in the prevention of preeclampsia and corresponding complications: a meta-analysis of RCTs.
        Arch Gynecol Obstet. 2022; 305: 1465-1479
        • Henderson JT
        • Vesco KK
        • Senger CA
        • Thomas RG
        • Redmond N.
        Aspirin use to prevent preeclampsia and related morbidity and mortality: updated evidence report and systematic review for the US Preventive Services Task Force.
        JAMA. 2021; 326: 1192-1206
        • Cui Y
        • Zhu B
        • Zheng F.
        Low-dose aspirin at ≤16 weeks of gestation for preventing preeclampsia and its maternal and neonatal adverse outcomes: a systematic review and meta-analysis.
        Exp Ther Med. 2018; 15: 4361-4369
        • Duley L
        • Meher S
        • Hunter KE
        • Seidler AL
        • Askie LM.
        Antiplatelet agents for preventing pre-eclampsia and its complications.
        Cochrane Database Syst Rev. 2019; 2019CD004659
        • Vainio M
        • Kujansuu E
        • Iso-Mustajarvi M
        • Mäenpää J.
        Low dose acetylsalicylic acid in prevention of pregnancy-induced hypertension and intrauterine growth retardation in women with bilateral uterine artery notches.
        BJOG. 2002; 109: 161-167
        • Ebrashy A
        • Ibrahim M
        • Marzook A
        • Yousef D.
        Usefulness of aspirin therapy in high-risk pregnant women with abnormal uterine artery Doppler ultrasound at 14-16 weeks pregnancy: randomized controlled clinical trial.
        Croat Med J. 2005; 46: 826-831
        • Rumack CM
        • Guggenheim MA
        • Rumack BH
        • Peterson RG
        • Johnson ML
        • Braithwaite WR.
        Neonatal intracranial hemorrhage and maternal use of aspirin.
        Obstet Gynecol. 1981; 58: 52S-56S
        • Hertz-Picciotto I
        • Hopenhayn-Rich C
        • Golub M
        • Hooper K.
        The risks and benefits of taking aspirin during pregnancy.
        Epidemiol Rev. 1990; 12: 108-148
        • Turner JM
        • Robertson NT
        • Hartel G
        • Kumar S.
        Impact of low-dose aspirin on adverse perinatal outcome: meta-analysis and meta-regression.
        Ultrasound Obstet Gynecol. 2020; 55: 157-169