Objectif(s) de la recherche et intérêt pour la santé publique

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The increasingly wide use of low-dose aspirin during pregnancy to prevent preeclampsia, based on recently updated clinical guidelines, raises debates about potential maternal bleeding risks. This population-based study aimed to quantify the risk of hemorrhage complications associated with aspirin exposure.
We performed a nationwide exposed/unexposed cohort study using the French National Health Data System (SNDS), analyzing 5,774,333 pregnancies between 2015 and 2021. Exposure was defined as a low-dose aspirin prescription (75–160 mg/day) during pregnancy (2.98% of the cohort). The primary endpoint was a hospital stay for maternal hemorrhage during the 1st, 2nd/3rd trimesters, or the postpartum period. Risk was evaluated using a Cox survival regression.
Aspirin exposure was associated with a significantly increased risk of maternal hemorrhage: during the first trimester (Hazard Ratio [HR] 2.87 [95% CI 2.56–3.21]), the second and third trimesters (HR 1.74 [1.65–1.84]), and post-partum (HR 1.44 [1.32–1.57]). The study also estimated the number of attributable bleeding complications based on varying prevalence levels.
The prescription of low-dose aspirin during pregnancy is associated with an increased risk of maternal bleeding complications. These findings suggest the need to reconsider widespread usage and emphasize precise patient selection to ensure aspirin is reserved for those who genuinely benefit.