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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (6): 1074-1080. doi: 10.19723/j.issn.1671-167X.2025.06.009

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Impact of aspirin use on pregnancy outcomes in patients with systemic lupus erythematosus

Xinyi LI, Jinxia ZHAO, Rong MU*()   

  1. Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
  • Received:2025-08-18 Online:2025-12-18 Published:2025-10-24
  • Contact: Rong MU

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Abstract:

Objective: To evaluate the use of aspirin during pregnancy in patients with systemic lupus erythematosus (SLE) and to assess its effects on pregnancy outcomes. Methods: We consecutively enrolled SLE patients discharged from the Department of Obstetrics at Peking University Third Hospital between 2010 and 2024. Collected data included general patient characteristics, such as age, histories of adverse pregnancy, thrombosis, hypertension and renal disease. SLE related organ involvement, antiphospholipid antibodies (aPLs), SLE disease activity index (SLEDAI) score, medication regimens during pregnancy, and pregnancy outcomes were all documented. Differences in clinical characteristics between the aspirin user group and the non-user group were compared. Logistic regression analysis was used to assess the impact of aspirin on pregnancy outcomes. Results: A total of 171 SLE patients were included in this study. The mean age was (31±4) years, and 46 patients had a history of adverse pregnancy. The most commonly involved organs were skin and joints, accounting for 68.4% and 45.6% respectively. In the study, 52 cases had renal involvement, accounting for 30.4%. SLEDAI scores during pregnancy of the 87.1% patients were less than 4 scores. Aspirin use during pregnancy accounted for 48.5%. Among them, 19 patients (11.1%) used between 2010 and 2017, while 64 patients (37.4%) used after 2017, demonstrating an increasing trend. Regarding pregnancy outcomes, the rates of fetal loss, preterm birth, preeclampsia/eclampsia, and early-onset preeclampsia were 14.0%, 23.4%, 22.8%, and 10.5%, respectively. After adjusting for covariates such as age, adverse pregnancy history, SLEDAI score, and aPLs, aspirin use was a protective factor for live birth (OR=2.34, 95%CI: 1.18－4.65, P=0.015) and reduced the incidence of preeclampsia/eclampsia and early-onset preeclampsia (OR=0.42, 95%CI: 0.19－0.91, P=0.028; OR=0.31, 95%CI: 0.11－0.89, P=0.029, respectively) for the total 171 SLE patients. Among the SLE pregnant patients without high-risk factors for preeclampsia/eclampsia, aspirin use was a protective factor for live birth (OR=8.22, 95%CI: 1.61－42.16, P=0.012) and might help reduce the incidence of early-onset preeclampsia/eclampsia (OR=0.26, 95%CI: 0.06－1.10, P=0.067). Conclusion: Aspirin can reduce the incidence of preeclampsia/eclampsia, early-onset preeclampsia, and stillbirth in pregnant SLE patients. Even for those without high-risk factors for preeclampsia/eclampsia, aspirin should be taken under physician evaluation and recommendation. Current clinical practice in managing SLE during pregnancy deviates from guideline recommendations, underscoring the need for greater standardization.

Key words: Systemic lupus erythematosus, Pregnancy, Aspirin, Pregnancy outcome

CLC Number: 

  • R714.25

Table 1

Baseline characteristics of 171 SLE patients"

Characteristic Data
Age/years 31.0±3.9
Adverse pregnancy history 46 (26.9)
Gestational SLEDAI score
    Inactive 149 (87.1)
    Active 22 (12.9)
Organ involvement
    Skin 117 (68.4)
    Joints 78 (45.6)
    Hematological 42 (24.6)
    Renal 52 (30.4)
    Neurological 9 (5.3)
    Muscular 3 (1.7)
    Fever 41 (24.0)
    Thrombosis history 7 (4.1)
    aPLs positive 33 (19.3)
Medications during pregnancy
    Glucocorticoids 143 (83.6)
    Hydroxychloroquine 157 (91.8)
    Aspirin 83 (48.5)
    LMWH 52 (30.4)
    Immunosuppressants 50 (29.2)

Table 2

Comparison of clinical characteristics between aspirin user and non-user groups in 171 SLE pregnant patients"

Characteristic Aspirin user (n=83) Non-user (n=88) P
Age/years 31.9±3.4 30.2±4.2 0.003
Adverse pregnancy history 28 (33.7) 18 (20.5) 0.052
Gestational SLEDAI Score
    Inactive 78 (94.0) 71 (80.7) 0.009
    Active 5 (6.0) 17 (19.3)
Clinical manifestations
    Skin 57 (68.7) 60 (68.2) 0.949
    Joints 35 (42.2) 43 (48.9) 0.382
    Hematological 21 (25.3) 21 (23.9) 0.826
    Renal 29 (34.9) 23 (26.1) 0.211
    Neurological 5 (6.0) 4 (4.6) 0.741
    Muscular 1 (1.2) 2 (2.3) >0.999
    Fever 22 (26.5) 19 (21.6) 0.456
Thrombosis history 3 (3.6) 4 (4.5) >0.999
aPLs positive 25 (30.1) 11 (12.5) 0.004
Medications during pregnancy
    Glucocorticoids 72 (86.7) 71 (80.7) 0.293
    Hydroxychloroquine 81 (97.6) 77 (87.5) 0.013
    LMWH 37 (44.6) 14 (15.9) < 0.001
    Immunosuppressants 30 (36.1) 20 (22.7) 0.049
Pregnancy outcomes
    Live birth 75 (90.4) 72 (81.8) 0.108
    Preeclampsia/eclampsia 19 (22.9) 20 (22.7) 0.979
    Early-onset preeclampsia/eclampsia 7 (8.4) 11 (12.5) 0.387
    Adverse pregnancy outcomes 40 (48.2) 52 (59.1) 0.151

Table 3

Logistic regression analysis of the impact of aspirin use on pregnancy outcomes in SLE pregnant patients"

Variable OR 95%CI P
Pregnancy outcome 1: Live birth
    Aspirin use 2.34 1.18-4.65 0.015
    Age 0.97 0.90-1.04 0.376
    Adverse pregnancy history 0.52 0.27-1.00 0.050
    Gestational SLEDAI score 0.30 0.12-0.72 0.007
    aPLs positive 0.35 0.16-0.76 0.008
    Hydroxychloroquine use 2.46 0.84-7.21 0.102
    LMWH use 1.35 0.64-2.84 0.431
    Immunosuppressants use 0.78 0.40-1.52 0.463
Pregnancy outcome 2: Preeclampsia/eclampsia
    Aspirin use 0.42 0.19-0.91 0.028
    Age 1.02 0.93-1.11 0.718
    Adverse pregnancy history 1.25 0.63-2.48 0.525
    Gestational SLEDAI score 2.68 1.18-6.09 0.019
    aPLs positive 1.56 0.75-3.25 0.234
    Hydroxychloroquine use 0.65 0.25-1.70 0.381
    LMWH use 1.18 0.58-2.41 0.649
    Immunosuppressants use 1.42 0.73-2.76 0.302
Pregnancy outcome 3: Early-onset preeclampsia/eclampsia
    Aspirin use 0.31 0.11-0.89 0.029
    Age 0.96 0.85-1.08 0.487
    Adverse pregnancy history 1.42 0.56-3.61 0.456
    Gestational SLEDAI score 3.82 1.45-10.08 0.007
    aPLs positive 2.45 1.02-5.89 0.045
    Hydroxychloroquine use 0.42 0.11-1.62 0.208
    LMWH use 1.85 0.75-4.56 0.182
    Immunosuppressants use 1.68 0.68-4.16 0.261
Pregnancy outcome 4: Adverse pregnancy outcomes
    Aspirin use 0.58 0.32-1.05 0.071
    Age 1.04 0.97-1.12 0.312
    Adverse pregnancy history 1.48 0.83-2.64 0.186
    Gestational SLEDAI score 2.25 1.05-4.82 0.037
    aPLs positive 1.92 1.02-3.62 0.044
    Hydroxychloroquine use 0.78 0.35-1.74 0.542
    LMWH use 1.34 0.74-2.43 0.337
    Immunosuppressants use 1.28 0.73-2.25 0.386

Table 4

Comparison of clinical characteristics between aspirin user and non-user groups in SLE pregnant patients without high-risk factors for preeclampsia"

Characteristic Aspirin user (n=30) Non-user (n=54) P
Age/years 31.6±4.1 30.4±4.6 0.223
Adverse pregnancy history 9 (30.0) 18 (33.3) 0.755
Gestational SLEDAI score
    Inactive 29 (96.7) 50 (92.6) 0.650
    Active 1 (3.3) 4 (7.4)
Clinical manifestations
    Skin 20 (66.7) 36 (66.7) 0.540
    Joints 13 (43.3) 29 (53.7) 0.362
    Hematological 6 (20.0) 9 (16.7) 0.700
    Neurological 0 (0) 2 (3.7) 0.535
    Muscular 1 (3.3) 1 (1.9) 1.000
    Fever 10 (33.3) 12 (22.2) 0.267
Medications during pregnancy
    Glucocorticoids 26 (86.7) 45 (83.3) 0.692
    Hydroxychloroquine 30 (100) 50 (92.6) 0.292
    LMWH 8 (26.7) 3 (5.6) 0.012
    Immunosuppressants 10 (33.3) 11 (20.4) 0.189
Pregnancy outcomes
    Live birth 30 (100.0) 48 (88.9) < 0.001
    Preeclampsia/eclampsia 4 (13.3) 6 (11.1) 0.763
    Early-onset preeclampsia/eclampsia 1 (3.3) 1 (1.9) 0.669
    Adverse pregnancy outcomes 11 (36.7) 26 (48.1) 0.310

Table 5

Logistic regression analysis of the impact of aspirin use on pregnancy outcomes in SLE pregnant patients without high-risk factors for preeclampsia"

Variable OR 95%CI P
Pregnancy outcome 1: Live birth
    Aspirin use 8.22 1.61-42.16 0.012
    Age 0.96 0.87-1.07 0.465
    Gestational SLEDAI score 1.24 0.80-1.91 0.330
    Hydroxychloroquine use 6.31 1.10-36.26 0.039
    LMWH use 0.59 0.13-2.74 0.503
Pregnancy outcome 2: Preeclampsia/eclampsia
    Aspirin use 0.44 0.13-1.50 0.191
    Age 1.05 0.96-1.15 0.256
    Gestational SLEDAI score 1.31 0.89-1.91 0.168
    Hydroxychloroquine use 0.48 0.14-1.70 0.255
    LMWH use 0.65 0.17-2.51 0.534
Pregnancy outcome 3: Early-onset preeclampsia/eclampsia
    Aspirin use 0.26 0.06-1.10 0.067
    Age 1.07 0.96-1.18 0.216
    Gestational SLEDAI score 1.46 0.96-2.22 0.077
    Hydroxychloroquine use 0.38 0.09-1.68 0.205
    LMWH use 0.41 0.08-2.02 0.272
Pregnancy outcome 4: Adverse pregnancy outcomes
    Aspirin use 0.68 0.24-1.93 0.466
    Age 1.03 0.95-1.12 0.514
    Gestational SLEDAI score 1.21 0.84-1.74 0.307
    Hydroxychloroquine use 0.66 0.22-2.01 0.465
    LMWH use 1.37 0.24-1.93 0.466
1
Singh M , Wambua S , Lee SI , et al. Autoimmune diseases and adverse pregnancy outcomes: An umbrella review[J]. Lancet, 2023, 402 (Suppl 1): S84.
2
Clowse MEB , Jamison M , Myers E , et al. A national study of the complications of lupus in pregnancy[J]. Am J Obstet Gynecol, 2008, 199 (2): 127.e1- 127.e6.

doi: 10.1016/j.ajog.2008.03.012
3
Buyon JP , Kim MY , Guerra MM , et al. Predictors of pregnancy outcomes in patients with lupus[J]. Ann Intern Med, 2015, 163 (3): 153- 163.

doi: 10.7326/M14-2235
4
Sangah AB , Jabeen S , Hunde MZ , et al. Maternal and fetal outcomes of SLE in pregnancy: A literature review[J]. J Obstet Gynaecol, 2023, 43 (1): 2205513.

doi: 10.1080/01443615.2023.2205513
5
Schramm AM , Clowse MEB . Aspirin for prevention of preeclampsia in lupus pregnancy[J]. Autoimmune Dis, 2014, 2014, 920467.
6
Roberge S , Villa P , Nicolaides K , et al. Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: A systematic review and meta-analysis[J]. Fetal Diagn Ther, 2012, 31 (3): 141- 146.

doi: 10.1159/000336662
7
Duley L , Henderson-Smart DJ , Meher S , et al. Antiplatelet agents for preventing pre-eclampsia and its complications[J]. Cochrane Database Syst Rev, 2007, 18 (2): CD004659.
8
Hoffman MK , Goudar SS , Kodkany BS , et al. Low-dose aspirin for the prevention of preterm delivery in nulliparous women with a singleton pregnancy (ASPIRIN): A randomised, double-blind, placebo-controlled trial[J]. Lancet, 2020, 395 (10220): 285- 293.

doi: 10.1016/S0140-6736(19)32973-3
9
Fanouriakis A , Kostopoulou M , Andersen J , et al. EULAR recommendations for the management of systemic lupus erythematosus: 2023 update[J]. Ann Rheum Dis, 2024, 83 (1): 15- 29.

doi: 10.1136/ard-2023-224762
10
Andreoli L , Bertsias GK , Agmon-Levin N , et al. EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome[J]. Ann Rheum Dis, 2017, 76 (3): 476- 485.

doi: 10.1136/annrheumdis-2016-209770
11
Sammaritano LR , Bermas BL , Chakravarty EE , et al. 2020 American college of rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases[J]. Arthritis Rheumatol, 2020, 72 (4): 529- 556.

doi: 10.1002/art.41191
12
Hochberg MC . Updating the American college of rheumatology revised criteria for the classification of systemic lupus erythematosus[J]. Arthritis Rheum, 1997, 40 (9): 1725.
13
Dhariwal NK , Lynde GC . Update in the management of patients with preeclampsia[J]. Anesthesiol Clin, 2017, 35 (1): 95- 106.

doi: 10.1016/j.anclin.2016.09.009
14
Mendel A , Bernatsky SB , Hanly JG , et al. Low aspirin use and high prevalence of pre-eclampsia risk factors among pregnant women in a multinational SLE inception cohort[J]. Ann Rheum Dis, 2019, 78 (7): 1010- 1012.

doi: 10.1136/annrheumdis-2018-214434
15
Palmsten K , Simard JF , Chambers CD , et al. Medication use among pregnant women with systemic lupus erythematosus and general population comparators[J]. Rheumatology (Oxford), 2017, 56 (4): 561- 569.
16
Moroni G , Doria A , Giglio E , et al. Fetal outcome and recommendations of pregnancies in lupus nephritis in the 21st century. A prospective multicenter study[J]. J Autoimmun, 2016, 74, 6- 12.

doi: 10.1016/j.jaut.2016.07.010
17
ACOG committee opinion No. 743 summary: Low-dose aspirin use during pregnancy[J]. Obstet Gynecol, 2018, 132(1): 254-256.
18
LeFevre ML . Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: U.S. preventive services task force recommendation statement[J]. Ann Intern Med, 2014, 161 (11): 819- 826.

doi: 10.7326/M14-1884
19
Tani C , Zucchi D , Haase I , et al. Impact of low-dose acetylsalicylic acid on pregnancy outcome in systemic lupus erythematosus: Results from a multicentre study[J]. Lupus Sci Med, 2022, 9 (1): e000714.

doi: 10.1136/lupus-2022-000714
20
Zhang N , Zhang HX , Li YW , et al. Benefits of hydroxychloroquine combined with low-dose aspirin on pregnancy outcomes and serum cytokines in pregnant women with systemic lupus erythematosus[J]. Drugs R D, 2023, 23 (1): 35- 42.

doi: 10.1007/s40268-022-00408-0
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