Low Dose Aspirin for Primary Prevention of Adverse Pregnancy Outcome

Background: Pregnancy is associated with various complications such as pre-eclampsia, SGA, preterm birth etc. Low dose aspirin is a possible medication to minimize these adverse outcomes. The aim of this study was to evaluate the use of low dose aspirin for primary prevention of adverse pregnancy outcome. Material & Methods: This cross-sectional study was conducted in department of Gynaecology, North Bengal Medical College Hospital, Mirjapur Bkash Hospital, Mirjapur, Tangail, Bangladesh, during the period from June 2021 to August 2022. Total 200 pregnant women were included in this study. Results: In this study, the mean (±SD) age of the study subjects were 25.12 ± 5.49 years and 25.00 ± 4.83 years in LDA group and control group, respectively. There was no statistically significant (p>0.05) difference in age between the groups. The rate of caesarean section was higher in control group (68%) compared to LDA group (59%) but there was no statistically significant (p>0.05) difference among the groups. In our study, 8% pregnant women in LDA group and 19% pregnant women in control group had gestational hypertension, pre-eclampsia was seen in 6% and 13% pregnant women in LDA group and control group, respectively, preterm birth was seen in 8% and 17% pregnant women in LDA group and control group, respectively, SGA was seen in 19% and 32% pregnant women in LDA group and control group, respectively, and fetal distress was seen in 2% pregnant women in both LDA group and control group. There were statistically significant (p<0.05) differences in complications except fetal distress. Mean (±SD) neonatal birth weight was 2.88±1.03 kg and 2.74±0.85 kg in LDA group and control group, respectively and there was no statistically significant (p>0.05) difference. Conclusion: We found that low dose aspirin could significantly reduce the risk of adverse outcomes, especially for pre-eclampsia, SGA and preterm birth.

Evaluation of the Effect of Low-dose Aspirin on the Prevention of Preterm Delivery in Women with a History of Spontaneous Preterm Delivery / Avaliação do efeito da aspirina em baixa dose na prevenção do parto prematuro em mulheres com história de parto prematuro espontâneo

Abstract Objective Currently, uteroplacental vascular disorders are considered one of the main mechanisms of spontaneous preterm delivery (PTD). Low-dose aspirin is used to prevent pre-eclampsia, which has a similar mechanism; hence, the present study aimed to investigate the effect of low-dose aspirin on the prevention of PTD in women with a history of spontaneous PTD. Methods The present pilot randomized clinical trial was conducted on 54 pregnant women in the aspirin group (taking 80 mg daily until the 36th week and classic treatment) and 53 patients in the control group (only receiving classic treatment). Results Forty-three patients (40%) presented before 37 weeks due to symptoms of PTL. Preterm delivery (< 37 weeks) occurred in 28 patients (26%), and there was no significant difference between the aspirin and control groups (10 patients [19%] and 18 patients [34%], respectively; p = 0.069). The time of preterm delivery was early (< 34 weeks) in 6 patients (21%), and its cause was spontaneous labor in 23 patients (82%) which was not significantly different between the two groups (p > 0.05). Out of 40 patients with spontaneous labor, 25 patients (63%) had a PTD, which was significantly lower in the aspirin group than in the control group (9 patients [45%] versus 16 patients [80%], respectively; p = 0.022). Conclusion The findings of the present study demonstrated that despite the reduction in the incidence of PTD using low-dose aspirin, the reduction rate was not statistically significant. On the other hand, in patients with spontaneous labor prone to PTD, aspirin was effective in reducing the incidence of PTD.

Resumo Objetivo Atualmente, os distúrbios vasculares uteroplacentários são considerados um dos principais mecanismos de parto prematuro espontâneo (PTD). A aspirina em baixa dose é usada para prevenir a pré-eclâmpsia, que tem um mecanismo semelhante; portanto, o presente estudo teve como objetivo investigar o efeito da aspirina em baixa dosagem na prevenção de PTD em mulheres com história de PTD espontâneo. Métodos O presente ensaio clínico piloto randomizado foi realizado em 54 gestantes do grupo aspirina (tomando 80 mg diários até a 36ª semana e tratamento clássico) e 53 pacientes do grupo controle (somente tratamento clássico). Resultados Quarenta e três pacientes (40%) apresentaram-se antes de 37 semanas devido a sintomas de PTL. O parto prematuro (< 37 semanas) ocorreu em 28 pacientes (26%) e não houve diferença significativa entre os grupos aspirina e controle (10 pacientes [19%] e 18 pacientes [34%], respectivamente; p = 0,069). O tempo de parto prematuro foi precoce (< 34 semanas) em 6 pacientes (21%) e sua causa foi trabalho de parto espontâneo em 23 pacientes (82%) que não foi significativamente diferente entre os dois grupos (p > 0,05). Das 40 pacientes com trabalho de parto espontâneo, 25 pacientes (63%) tiveram PTD, que foi significativamente menor no grupo aspirina do que no grupo controle (9 pacientes [45%] versus 16 pacientes [80%], respectivamente; p = 0,022). Conclusão Os achados do presente estudo demonstraram que, apesar da redução na incidência de DPT com o uso de aspirina em baixa dosagem, a taxa de redução não foi estatisticamente significativa. Por outro lado, em pacientes com trabalho de parto espontâneo propensas a PTD, a aspirina foi eficaz na redução da incidência de PTD.

Comparative study of low dose aspirin versus combination of low dose aspirin and low molecular weight heparin in idiopathic recurrent pregnancy loss

Background: To compare the role of low dose aspirin versus combination of low dose aspirin and low molecular weight heparin in idiopathic recurrent pregnancy loss and assess the effectiveness of low dose aspirin and low molecular weight heparin in having a better obstetric outcome.Methods: This study was conducted in a private hospital in Mahabubnagar from June 2017 to May 2019. A total of 80 pregnant ladies who had previous 2 and or more pregnancy losses in the early (before 20 weeks) or late (after 20 weeks) pregnancy period was included in the study. 80 pregnant women with idiopathic/unexplained recurrent pregnancy loss were properly evaluated in regard to the history of previous period of gestation of loss, previous scans in regard to documentation of fetal pole and gestation, cardiac activity, anomaly scan and growth scan and any special investigations in previous pregnancies and present pregnancy.Results: A total 80 pregnant women with previous 2 and more unexplained pregnancy losses who were evaluated and found negative with major causes of pregnancy losses half of them (40) were treated with low dose aspirin alone and the other 40 women were treated with a combination of low dose aspirin (75 mg) and low molecular weight Heparin (20 mg) daily low molecular weight heparin till term. The aspirin alone group had 82.5% live birth rate and the combination group had 92.5% live birth rate which is quite satisfactory and more than the Aspirin alone group.Conclusions: Use of combination of low dose aspirin and low molecular weight heparin seems to be a good choice of drugs in treating the unexplained recurrent pregnancy losses than low dose aspirin alone.

Long term Low-Dose Aspirin Therapy: Is Gastric Protection Necessary?

Aspirin is commonly used in primary and secondary prevention of cardiovascular events. However, its long-term use leads to gastrointestinal compromise, such as gastric mucosal erosions, peptic ulcer, and GI bleeding. These complications are common in our daily clinical practice, as illustrated in the case of a 67-year-old male who has ischaemic heart disease and was on long-term aspirin without any gastric protection for 9 years. He was subsequently admitted for bleeding from gastric ulcers and diagnosed to be positive for H. pylori infection. The risk factors for GI damage and bleeding, and the evidence for gastric protection in long-term aspirin users are reviewed here. High-risk patients, such as those with a history of ulcer disease or gastrointestinal bleeding, should undergo screening and treatment of H. pylori infection. Concomitant use of proton-pump inhibitors is recommended as they are superior to histamine-2 receptor antagonists in prevention of GI bleeding. PPI use should also be encouraged if patients have two or more of the following risk factors: over 60 years old, corticosteroid use, dyspepsia, or gastroesophageal reflux disease symptoms. Further research is needed to determine if H. pylori screening is required prior to commencement of long-term aspirin in the general population.

Interpretation of Japan“Evidence-based Clinical Practice Guidelines for Peptic Ulcer Disease 2015” / 胃肠病学

The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for peptic ulcer disease in 2015. The revised guidelines consist of the following items:bleeding gastric and duodenal ulcers, Helicobacter pylori(Hp)eradication therapy and non-eradication therapy,drug-induced ulcer,non-Hp/ non-nonsteroidal anti-inflammatory drug( NSAID)-induced ulcer,and surgical treatment. This guideline describes the abovementioned content in detail and is a good reference for clinical practice. A full interpretation of this guideline was performed in this paper.

A Case of Pregnancy in Essential Thrombocythaemia with Low dose Aspirin Treatment / 대한주산의학회잡지

Essential thrombocythaemia (ET) is a chronic myeloproliferative disorder characterized by markedly elevated platelet count in the peripheral blood due to an excessive proliferation of bone marrow megakaryocytes. The pregnancy outcome among patients with ET is mostly successful but adverse outcome due to thrombotic and bleeding complications is a matter of concern: miscarriage, intrauterine growth retardation, abruptio placenta, intrauterine fetal death and preterm delivery. Various treatments such as acetylsalicylic acid, hydroxyurea, anagrelide, heparin, interferon alpha and plateletpheresis have been proposed to improve the pregnancy outcome. We report a case of pregnant woman in condition of ET who succeeded in normal vaginal delivery without specific obstetric complications after low dose aspirin therapy during pregnancy.

Effect of Low-dose Aspirin on Implantation and Pregnancy Rates in Patients Undergoing Frozen-thawed Embryo Transfer / 대한불임학회지

OBJECTIVE: Low-dose aspirin have been proposed to improving endometrial receptivity and pregnancy rate in COH-IVF by increasing endometrial perfusion. However, the effect of low-dose aspirin in COH-IVF could be negligible because there have been large quantity of other important factors responsible for changing endometrial perfusion accompanied by COH procedure. In contrast, in frozen-thawed embryo transfer cycles which were not accompanied by COH procedure, the effects of low-dose aspirin in endometrial blood flow seems to be more certain than in COH-IVF cycles. In this study, we analyzed the effect of low-dose aspirin treatment on implantation and pregnancy rates in patients undergoing frozen-thawed embryo transfer METHODS: From January 2003 to December 2003, total 264 cycles from 264 patients who attended infertility clinic at Samsung Cheil Hospital were enrolled in this study. All cases included in this study, embryos were frozen and thawed at the pronuclear stage and three days after incubation, at least 2 or more good quality embryos were transferred into uterus. In study group, low dose aspirin (100 mg/day) was administrated from the first or second date of menstrual day to 9 days after embryo transfer. On the other hand, control group did not take any medicine except estradiol valerate for endometrial priming. Several variables including implantation and pregnancy rates were compared in both groups. After then, each groups were stratified by endometrial thickness checked at embryo transfer (ET) day such as (28 mm versus 0.05) After we analyzed same variables stratified by endometrial thickness checked at embryo transfer day, we could not found any significant difference between study and control groups. CONCLUSIONS: Low-dose aspirin treatment seems to have no advantage of improving implantation and pregnancy rates in patients undergoing frozen-thawed embryo transfer.

Clinical Efficacy of Low-dose Aspirin and Prednisolone in Controlled Ovarian Hyperstimulation for In Vitro Fertilization and Embryo Transfer / 대한산부인과학회지

OBJECTIVE: To determine whether the use of low-dose aspirin and prednisolone in controlled ovarian hyperstimulation (COH) with GnRH agonist long protocol improves the outcomes of in vitro fertilization and embryo transfer (IVF-ET). METHODS: Two hundred and forty IVF-ET cycles were assigned to four groups: control group (aspirin(-) and prednisolone(-), n=59), low-dose aspirin group (aspirin(+) and prednisolone(-), n=43, Group 1), prednisolone group (aspirin(-) and prednisolone(+), n=80, Group 2), and low-dose aspirin and prednisolone group (aspirin(+) and prednisolone(+), n=58, Group 3). The COH and pregnancy outcomes were retrospectively compared among the four groups. RESULTS: Group 1 showed higher fertilization rate with a borderline significance compared to control group (73.6% vs. 64.1%, p=0.050). Serum estradiol (E2) level on hCG day was 995.5+/-767.5 pg/mL in control group, 1,550.7+/-1,254.5 pg/mL in group 1, 1,469.2+/-1,206.6 pg/mL in group 2 and 1,796.0+/-1,548.0 pg/mL in group 3 and higher in the three treatment groups compared to control (p=0.012, p=0.006, p<0.001, respectively). Embryo score per transferred embryo was also higher in Group 1 (17.4+/-8.4, p=0.001) and 3 (16.0+/-6.1, p<0.001) compared to control (12.2+/-5.1). There were no significant differences in the implantation and the pregnancy rates among the four groups. CONCLUSION: The use of low-dose aspirin or prednisolone may be beneficial in IVF-ET patients undergoing COH with GnRH agonist long protocol. Further larger-scale prospective randomized investigations are necessary to confirm these findings.

Effectiveness of Low Dose Aspirin and Prednisolone Supplementation for IVF-ET / 대한산부인과학회잡지

OBJECTIVE: To estimate the efficacy of low-dose aspirin and prednisolone supplementation in women undergoing controlled ovarian hyperstimulation (COH) for in vitro fertilization and embryo transfer (IVF-ET). METHODS: From 1 July 2001 to 31 July 2002, A total of 306 cycles from 306 patients who attended infertility clinic at Samsung Cheil Hospital was enrolled in this study. With pituitary desensitization in a short gonadotrophin-releasing hormone (GnRH) agonist protocol, recombinant FSH (Puregon, Organon, Netherlands) was administered for ovarian stimulation, until the largest follicle had a mean diameter > 18 mm and at least two other follicles with a diameter of 16 mm. In study group (128 cycles), low dose aspirin (100 mg/day) and prednisolone (5 mg/day) were administered from COH starting day to post-oocyte retrieval 12th day. The COH protocol of control group (178 cycles) was same as study group, except no additional supplementation. Retrospectively, we analysed ovarian response and outcome of IVF cycles. RESULTS: The demographic characteristics of two groups were not different. E2 on hCG day (2408.3+/-1375.4 pg/ml vs 2232.3+/-1305.1 pg/ml: p=0.261), number of retrieved oocytes (13.1+/-9.1 vs 12.5+/-8.8: p=0.680), number of good embryos transferred (3.0+/-2.5 vs 2.9+/-2.0) were not different significantly between two groups. hCG positive rate (52.3% vs 43.3%: p=0.116), biochemical pregnancy rate (23.9% vs 15.6%: p=0.224), clinical pregnancy rate (39.8% vs 36.5%: p=0.629), and clinical abortion rate (10.4% vs 6.5%: p=0.392) were not different significantly either. hCG positive rate (56.1% vs 44.7%: p=0.079) shows a increasing tendency in study group, younger than 35 years old. In study group, older than 36 years old or basal FSH > 10 mIU/ml, there were no significant improvement of ovarian response and prgnancy rate. CONCLUSION: Low dose aspirin and prednisolone supplementation in routine IVF patients shows no significant improvement in ovarian response, pregnancy rate, and implantation rate. Also, in poor ovarian responder, this supplementation shows no benefits.

Risk of Gastrointestinal Bleeding Associated with Use of Low-dose Aspirin in Korean Children / 대한소아소화기영양학회지

PURPOSE: To evaluate the risk of gastrointestinal bleeding associated with use of low-dose aspirin in children. METHODS: Among about 250 children who received low-dose aspirin (5 mg/kg/day) under the diagnosis of Kawasaki disease, from March 1995 to May 2001, at Eul-Ji general hospital, 100 children were enrolled in this study. We reviewed the medical records and interviewed the children's parents over the phone to confirm the existence of gross gastrointestinal bleeding. RESULTS: The age of the children at the beginning of medication ranged 4~118 months. About 75% of them was younger than 3 years old. The duration of medication ranged 0.5~17 months. About 70% of the children took the medicine for 2~3 months. Only 1 child (1%) had hematochezia during medication without any accompanying gastrointestinal symptom, and cimetidine for 1 week had cleared up the bleeding. The total duration of medication of 100 children was 341.5 months, and only 1 child had gastrointestinal bleeding. This translates into a rate of clinically significant gastrointestinal bleeding of 3.5 episodes/100 children/year. CONCLUSION: The long-term use of low-dose aspirin is safe, but, is associated with the risk of gastrointestinal bleeding in children. Careful follow-up and efforts to reduce the risk of gastrointestinal bleeding are necessary during long-term low-dose aspirin therapy in children.

The clinical efficacy of the low dose aspirin and corticosteroid treatment in patients with endometriosis who underwent in-vitro fertilization and embryo transfer (IVF-ET) / 대한산부인과학회잡지

OBJECTIVE: To investigate the efficacy of low-dose aspirin and corticosteroid in IVF-ET patients with endometriosis. MATERIALS AND METHODS: 45 infertile patients with endometriosis underwent 59 consecutive IVF-ET cycles. In the treatment group, 18 patients (23 cycles) underwent controlled ovarian hyperstimulation (COH) and received daily doses of 80 mg of aspirin and 15 mg of prednisone, starting on 3rd day of COH. In the control group, 27 patients (36 cycles) underwent COH without treatment. We analyzed the clinical characteristics, fertilization rates, good quality embryo ratio and pregnancy rates between these two groups. RESULTS: There was no difference between groups in clinical characteristics (mean age, parity, LH, FSH, estradiol, progesterone), fertilization rates, and good embryo ratio. However, implantation rates were significantly different (29.81% vs. 11.06%, p=0.019). Furthermore, hCG positive rates (60.89% vs. 41.67%), clinical pregnancy rates (56.52% vs. 33.33%), and on going pregnancy rates (>20weeks) (47.83% vs. 27.78%) were increased in the study group compared to the control group. CONCLUSIONS: Combined treatment of low dose aspirin and prednisone improved pregnancy rates and implantation rates in IVF-ET patients with endometriosis. This results confirm the hypothesis that autoantibodies subsequently react with endometrial antigen leading to implantation failure and that we need to further research to the relationship of endometriosis with the immunologic aspect of implantation.

The Effect of low-dose Aspirin and Clomiphene Citrate on the Expression of Neural Cell Adhesion Molecules (NCAM) in the Human Endometrium / 대한산부인과학회잡지

OBJECTIVE: The treatment with low-dose aspirin in the patients with unexplained infertility has been reported to improve the pregnancy rate and implantation rate via increasing the blood flow in the endometrium. But there are little known about the relationships between low-dose aspirin and cell adhesion molecules, NCAM. The aim of this study was to evaluate the effect of low-dose aspirin and clomiphene citrate treatment on the expression of NCAM in the endometrium. METHODS: The patients with unexplained infertility (N=37) were grouped into 3 groups: clomiphene citrate and low-dose aspirin treated group (N=8), clomiphene citrate treated group (N=10), and natural cycle group (N=10, no treatment). As control group, the proliferative and menopausal endometrium was used. Each endometium was obtained by endometrial biopsy performed in late luteal phase and immunohistochemical staining with NCAM was performed. RESULTS: In the stromal cells, the staining intensity of NCAM expression and the number of vessels were significantly increased in the endomterium treated with clomiphene citrate and low-dose aspirin compared with other groups (p<0.05). And the expression of NCAM in the prolifertive and menopausal endometrium showed very weak staining. CONCLUSION: The expression of NCAM in the stromal cells and the number of vessels were increased in the endometrium of unexplained infertility patients treated with clomiphene citrate and low-dose aspirin. These findings may suggest low-dose aspirin has an important role during the secretory phase of endometrium to improve the implantation via increasing the expression of cell adhesion molecules, especially NCAM and increasing the number of vessels.

The Efficacy of Low-dose Aspirin Therapy for Controlled Ovarian Hyperstimulation in IVF-ET / 대한불임학회지

OBJECTIVE: To evaluate the efficacy of low-dose aspirin on IVF outcome and endometrium in patients undergoing IVF-ET. MATERIALS AND METHODS: From February, 2001 to Jun, 2001, 60 infertile patients were randomly divided into study group (28 cycles) and control group (32 cycles). The study group received a daily oral dose of 25 mg of aspirin for at least 2 weeks from first visiting day. Controlled ovarian hyperstimulation was initiated in all patients with the GnRH agonist starting in the midluteal phase of the previous cycle. RESULTS: There were no significant differences in age of the patients, basal serum E2, LH, FSH level and endometrial thickness among two groups. There were no statistically significant differences between the study group and the control group respectively in dosage (26.5+/-4.8 vs 26.2+/-5.3 amples) and duration (10.4+/-4.2 vs 9.8+/-5.3 days) of gonadotropin administration, serum E2 level on the hCG administration day (1823+/-342 vs 1854+/-543), LH (14.5+/-2.7 vs 14.8+/-3.1), FSH (16.7+/-3.4 vs 18.3+/-4.7), the number of follicles p> 15 mm (13.2+/-6.3 vs 12.8+/-5.9), the number of oocytes retrieved (9.2+/-2.4 vs 8.4+/-1.7), the number of embryos transferred (4.7+/-2.0 vs 4.7+/-2.0), fertilization rate (68.4% vs 64.5%), implantation rate (21.3% vs 17.6%), and clinical pregnancy rate (28.4% vs 26.2%). The endometrial thickness and the percentage of endometrial trilaminar pattern on hCG day were significantly higher in study group than control group (12.9+/-3.7 mm vs 10.4+/-2.8 mm, 78.3% vs 64.5%). CONCLUSION: Many reports suggest that low-dose aspirin improve ovarian response, implantation rate, fertilization rate, implantation rate, and pregnancy rate by increasing the blood flow, but we couldn't prove the significant effect of low-dose aspirin on the IVF outcome except on endometrium. This may be affected by dose of aspirin, duration, and number of patients studied. This trial is small, so our results highlight the need for a large randomized controlled trial to identify the effect of low-dose aspirin on IVF-ET outcome.

Effect of Low-Dose Aspirin Therapy on Platelet Aggregation in Kawasaki Disease

PURPOSE: Aspirin(acetylsalicylic acid) has been used to treat unstable angina and acute myocardial infarction in adults and Kawasaki disease in children. The antithrombotic effect of aspirin was attributed to its ability to inhibit platelet aggregation by inhibiting platelet cyclooxygenase, which leads to decreased thromboxane synthesis. The purpose of this study was to evaluate the effect on the platelet aggregation by low dose aspirin in Kawasaki patients and to learn the side effects of low-dose aspirin. METHODS: Fifty patients with Kawasaki disease who were treated with low-dose aspirin, and 22 normal children were studied from Jan. 1996 to Dec. 1997. The platelet count, bleeding time, clotting time, platelet aggregation test(induced by ADP, epinephrine, collagen and ristocetin) and blood aspirin level by colorimetric method were checked. RESULTS: The platelet count, bleeding time, and clotting time in the patient group were not significantly different from the control group. The mean maximum platelet aggregation was 54.4+/-12.8% induced by ADP, 15.9+/-11.7% by epinephrine, 55.5+/-23.8% by collagen, 52.6+/-32.2% by ristocetin in the patient group. It was significantly lower than the control group(P<0.05). The mean blood aspirin level in the patient group was 5.4+/-3.7mg/dl. Side effects of low-dose aspirin were bruise, epistaxis and hematuria. CONCLUSION: Low-dose aspirin therapy in patients with Kawasaki disease inhibited platelet aggregation, but attention would be needed because of the tendency to bleed in these patients. Further investigations should be focused on the subject such as the onset of the maximal antiplatelet effect and time needed for the recovery of platelet function.

Clinical Efficacy of Doppler Ultrasound for Low Dose Aspirin Therapy in High Risk Pregnancy / 대한산부인과학회잡지

We investigated the capacity of low dose aspirin in reducing the incidence of pregnancy induced hypertension and affecting the pregnancy outcomes in women at high risk for this disorder. And we also studied the efficacy of Doppler ultrasound as an effective means of selecting a patient population of good candidate to administer low dose aspirin. Seventy women with chronic hypertension or a history of severe preeclampsia in their previous pregnancy were randomly assigned to treated group receiving low dose aspirin(60 mg/d, n=32) or control group(n=38). Daily administration of low dose aspirin could not prevent the development of pregnancy induced hypertension in the treated group(21.9% vs. 28.3%, p > 0.05). And there was no differences between the treated and control groups in the rates of emergency cesarean section for fetal distress(6.3% vs. 10.3%, p > 0.05), neonatal intensive care unit admission(9.4% vs. 15.8%, p > 0.05), fetal growth retardation(15.6% vs. 13.2%, p > 0.05), and perinatal death(3.1% vs. 7.9%, p > 0.05). In the group showing abnormal Doppler flow velocity waveform, aspirin seemed to improve the mean gestational age(35.7+/-2.8 vs. 34.4+/-3.1 weeks), birth weight(2271.9+/-730.8 vs. 1887.0+/-619.0 gm) and the pregnancy outcomes(31.3% vs. 60.6%), however, these results were not statistically significant(p > 0.05). This study suggests that low dose aspirin therapy is not effective in reducing the incidence of pregnancy induced hypertension. However, combination of Doppler ultrasound study with low doe aspirin therapy may improve pregnancy outcomes in women with high risk pregnancy.