Low-dose aspirin in pregnancy does not affect children’s neurodevelopment

Key takeaways:

• Cognitive scores were similar between children born to mothers who took vs. did not take aspirin during pregnancy.
• Researchers found no differences between the two groups in the Ages and Stages Questionnaire.

Prenatal low-dose aspirin exposure was not associated with negative neurodevelopmental outcomes in children by age 3 years, according to study results published in Obstetrics & Gynecology.

“Preeclampsia and preterm birth are the predominant drivers of poor obstetrical outcomes in the U.S. and abroad. Low-dose aspirin, particularly if given early in pregnancy, prevents many of these cases, but parents can be reluctant to take aspirin due to concern about the long-term implications to their children,” Matthew K. Hoffman, MD, MPH, FACOG, the Marie E. Pinizzotto, MD, endowed chair in the department of obstetrics and gynecology and director of the Center for Women & Children’s Health Research at Christiana Care in Newark, Delaware, told Healio. “This follow-up study of a large international trial, which showed the benefits of aspirin, should reassure parents that aspirin is safe and we found no differences in growth or neurodevelopment.”

Hoffman and colleagues conducted a multinational, noninferiority, masked, neurodevelopmental follow-up study of mothers who participated in the ASPIRIN study. This follow-up study included 640 children aged 33 to 39 months from mothers who had been randomly assigned to daily low-dose aspirin 81 mg (n = 329) or placebo (n = 311) between 6 and 13 weeks gestation through 37 weeks gestation. Researchers evaluated neurodevelopment using the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III) and the Ages and Stages Questionnaire, third edition (ASQ-3). Researchers evaluated all children from September 2021 to June 2022.

The primary outcome was a cognitive composite Bayley-III score.

The cognitive composite Bayley-III score was noninferior, with a mean cognitive composite score of 96 for children born to mothers who took aspirin during pregnancy and 96.8 for children born to mothers who did not take aspirin during pregnancy. Researchers observed no differences in the Bayley-III language or motor composite scores. There was also no difference in the proportion of children with any component of their Bayley-III score lower than 70 between those born to mothers who took aspirin and those who did not.

In addition, researchers noted no differences between the two groups in the communication, gross and fine motor, problem-solving and personal-social components of the ASQ-3.

Finally, researchers observed similar maternal characteristics, delivery outcomes, breastfeeding rates, breastfeeding duration and home environment between the two groups.

According to Hoffman, these findings may help patients and providers make decisions regarding aspirin use during pregnancy since results demonstrated no negative outcomes when initiating aspirin use as early as 6 weeks gestation.

“The use of low-dose aspirin 81 mg is becoming increasingly accepted by parents, providers and policymakers. We know that there are still gaps and need for education to ensure that it is equitably and consistently prescribed,” Hoffman said. “Nonetheless, the largest question is: Do we have the right dose? Increasingly, basic science is showing that preterm birth, birth and preeclampsia are related to maternal inflammation and higher doses may provide more protection. A number of trials, including one by our center, are preparing to answer this question.”

For more information:

Matthew Hoffman, MD, MPH, FACOG, can be reached at mhoffman@christianacare.org.