Does aspirin use worsen IBD severity in pregnant women?

The use of aspirin among pregnant patients with inflammatory bowel disease (IBD) does not appear to increase the risk of disease severity, reports a study. Low-dose aspirin (LDA) has been prescribed to nearly a third of IBD patients during pregnancy.

A total of 320 pregnancies in 232 women with IBD between 1 January 2013 and 31 December 2022 were included in the analysis. The authors ascertained LDA use from medication lists during pregnancy.

IBD flare during pregnancy or 6 months postpartum, defined as IBD-related hospitalization or surgery, new therapy initiation, elevated faecal calprotectin, or new active endoscopic disease, was the primary outcome.

Of the women, 90 (28 percent) received a prescription for aspirin during pregnancy. No significant difference was noted in the proportion of women with IBD flare during pregnancy or postpartum between those who were and were not prescribed aspirin (20 percent vs 26 percent; p=0.36).

Women prescribed LDA were older (median 35 vs 34 years), more likely to have preterm birth (21 percent vs 14 percent), higher parity (2 vs 1), and caesarean delivery (50 percent vs 27 percent) than those not on aspirin (p<0.01 for all).

The rates of hypertensive disorders of pregnancy (HDP) were comparable between the two groups, but women on LDA had higher rates of pre-eclampsia (10 percent vs 4.3 percent; p=0.10).

“LDA is recommended for pregnant individuals at elevated risk for HDP. However, regular aspirin use may raise concerns of increased disease activity in patients with IBD,” the authors said.