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

Behrokh  Sahebdel; Mohammad Nasir  Hematian; Zohreh  Heidary; Fatemeh  Golshahi; Nafiseh  Saedi; Fatemeh  Rahimi-Sharbaf; Mahboobeh  Shirazi; Arian  Tavasol; Gita Manzari  Tavakoli; Mohammad Hossein  Golezar; Hamed  Ghorani; Elham  Feizabad; Soudabeh  Rezaei

doi:10.18502/jri.v26i3.20181

Behrokh Sahebdel Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences, Tehran, Iran
Mohammad Nasir Hematian Department of Perinatology and Fetal Cardiology, Yas Hospital complex, Tehran University of Medical Sciences, Tehran, Iran
Zohreh Heidary Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
Fatemeh Golshahi Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences, Tehran, Iran
Nafiseh Saedi Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences, Tehran, Iran
Fatemeh Rahimi-Sharbaf Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences, Tehran, Iran
Mahboobeh Shirazi Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences, Tehran, Iran
Arian Tavasol Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Gita Manzari Tavakoli Pediatric Urology and Regenerative Medicine Research Center (PURMRC), Gene, Cell and Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
Mohammad Hossein Golezar Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
Hamed Ghorani Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
Elham Feizabad Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences, Tehran, Iran
Soudabeh Rezaei Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/jri.v26i3.20181

Keywords: Aspirin, Cardiovascular functions, Ultrasound imaging, Obstetrics

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.