Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

The Effect of Aspirin Administration on Fetal Cardiovascular Function Between 18 to 24 Weeks of Gestation: A New Perspective on ASA Indication in Obstetrics

Authors
Behrokh Sahebdel 1
Mohammad Nasir Hematian 2
Zohreh Heidary 3
Fatemeh Golshahi 1
Nafiseh Saedi 1
Fatemeh Rahimi-Sharbaf 1
Mahboobeh Shirazi 1
Arian Tavasol 4
Gita Manzari Tavakoli 5
Mohammad Hossein Golezar 6
Hamed Ghorani 6
Elham Feizabad 1
Soudabeh Rezaei 1
1 Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Perinatology and Fetal Cardiology, Yas Hospital complex, Tehran University of Medical Sciences, Tehran, Iran
3 Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
4 Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5 Pediatric Urology and Regenerative Medicine Research Center (PURMRC), Gene, Cell and Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
6 Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
10.18502/jri.v26i3.20181
Abstract
Background: Low-dose aspirin (ASA) is used in obstetrics for different indications, mainly to prevent preeclampsia. This study investigated the underlying mechanism of ASA’s effect on the fetus’s cardiovascular functions. Methods: 42 pregnant women at 18-24 weeks of gestation, identified as high-risk for preeclampsia, received 160 mg of ASA daily. Fetal Doppler ultrasound was performed before and three weeks after ASA treatment, assessing ductus venosus, middle cerebral, umbilical, and uterine arteries pulsatility indices as well as pulmonary, aorta, and superior vena cava (SVC) diameters in the three-vessel view, including pulmonary/aorta and SVC/aorta ratios. All analyses were performed using SPSS software version 27, with a significance threshold set at p<0.05. A paired t-test was used to assess differences in means. The Chi-square and Fisher’s exact test analyzed nominal variables. Results: Post-intervention analysis revealed significant improvements in abnormal uterine artery resistance (p<0.001) and abnormal pulsatility index of the umbilical artery, middle cerebral artery, and ductus venosus (p<0.001 for all). Moreover, 160 mg/day aspirin administration significantly increased mitral E/A (early filling velocity/atrial contraction velocity: 0.397±0.029; p<0.001), diameters of aorta (4.390±0.852; p<0.001), pulmonary artery (4.895±1.087; p<0.001), and SVC (2.511±0.535; p<0.001), while significantly decreasing left ventricular myocardial performance index (p<0.05). Conclusion: Daily administration of 160 mg of aspirin enhances fetal vascular and cardiac function. Evaluating fetal cardiovascular parameters beyond routine uterine artery Doppler, especially in high-risk pregnancies, and initiating ASA therapy in cases of insidious abnormalities, may help delay or prevent fetal complications such as intrauterine growth restriction (IUGR) by improving cardiovascular function.
Keywords
aspirin
Cardiovascular functions
Obstetrics
Ultrasound Imaging
  1. Salafia CM, Minior VK, Pezzullo JC, Popek EJ, Rosenkrantz TS, Vintzileos AM. Intrauterine growth restriction in infants of less than thirty-two weeks' gestation: associated placental pathologic features. Am J Obstet Gynecol. 1995;173(4):1049-57.
  2. Sekielska-Domanowska MI, Myszkowski B, Czuba B, Pietryga M, Cnota W, Dubiel M. The role of individual blood flow parameters through ductus venosus in the first and second trimesters of pregnancy in predicting the condition of the fetus and newborn. Ginekol Pol. 2022;93(7):558-63.
  3. Wallenburg HC, Rotmans N. Prevention of recurrent idiopathic fetal growth retardation by low-dose aspirin and dipyridamole. Am J Obstet Gynecol. 1987;157(5):1230-5.
  4. Wertaschnigg D, Reddy M, Mol BWJ, da Silva Costa F, Rolnik DL. Evidence-based prevention of preeclampsia: commonly asked questions in clinical practice. J Pregnancy. 2019;2019:2675101.
  5. Uzan S, Beaufils M, Bazin B, Danays T. Idiopathic recurrent fetal growth retardation and aspirin-dipyridamole therapy. Am J Obstet Gynecol. 1989;160(3):763-4.
  6. Lazzarin N, Vaquero E, Exacoustos C, Bertonotti E, Romanini ME, Arduini D. Low-dose aspirin and omega-3 fatty acids improve uterine artery blood flow velocity in women with recurrent miscarriage due to impaired uterine perfusion. Fertil Steril. 2009;92(1):296-300.
  7. Alsolai AA, Bligh LN, Greer RM, Kumar S. Correlation between fetoplacental Doppler indices and measurements of cardiac function in term fetuses. Ultrasound Obstet Gynecol. 2019;53(3):358-66.
  8. Akolekar R, Sarno L, Wright A, Wright D, Nicolaides KH. Fetal middle cerebral artery and umbilical artery pulsatility index: effects of maternal charac-teristics and medical history. Ultrasound Obstet Gynecol. 2015;45(4):402-8.
  9. Link G, Clark KE, Lang U. Umbilical blood flow during pregnancy: evidence for decreasing placental perfusion. Am J Obstet Gynecol. 2007;196(5):489.e1-7.
  10. Bower SJ, Harrington KF, Schuchter K, McGirr C, Campbell S. Prediction of pre‐eclampsia by abnormal uterine Doppler ultrasound and modification by aspirin. Br J Obstet Gynaecol. 1996;103(7):625-9.
  11. Veille JC, Hanson R, Sivakoff M, Swain M, Henderson L. Effects of maternal ingestion of low-dose aspirin on the fetal cardiovascular system. Am J Obstet Gynecol. 1993;168(5):1430-7.
  12. Grab D, Paulus WE, Erdmann M, Terinde R, Oberhoffer R, Lang D, et al. Effects of low-dose aspirin on uterine and fetal blood flow during pregnancy: results of a randomized, placebo-controlled. Ultrasound Obstet Gynecol. 2000;15(1):19-27.
  13. Bamfo JEAK, Odibo AO. Diagnosis and management of fetal growth restriction. J Pregnancy. 2011;2011:640715.
  14. Dall’Asta A, Brunelli V, Prefumo F, Frusca T, Lees CC. Early onset fetal growth restriction. Matern Health Neonatol Perinatol. 2017;3:2.
  15. Matsumoto‐Runser J, Ando K, Yoda H. EP04.06: High SVC/Ao ratio in 3-vessel view can be one of the indicators for the placental insufficiency. Ultrasound Obstet Gynecol. 2017;50(S1):270.
Journal of Reproduction & Infertility
Volume 26, Issue 3
Summer 2025
Pages 165-171