Barton J R, Sibai B M
University of Tennessee, Memphis.
Clin Obstet Gynecol. 1991 Jun;34(2):251-61. doi: 10.1097/00003081-199106000-00005.
The list of clinical conditions for which aspirin may produce abatement or reversal of pathologic processes continues to be expanded. There are, however, definite risks reported from the use of aspirin during pregnancy, even though some of the findings have been contradictory. Some of the potential adverse effects on the infant also remain unclear. Potential benefits from the use of low doses of aspirin during pregnancy (although promising) are still experimental. Large clinical trials in the United States and overseas are currently assessing the effectiveness of low-dose aspirin in preventing preeclampsia and fetal growth retardation. A review of the world's literature to date describes over 300 pregnancies in which low-dose aspirin has been used with no evidence of major adverse effects. Until more conclusive evidence emerges, however, caution against the indiscriminate use of aspirin in any dose during pregnancy is urged. Clinicians who decide to manage complicated or potentially complicated patients with chronic administration of aspirin must continue to study these mothers, fetuses, and neonates intensively and to document their results. Because of the fear of teratogenic effects in the first trimester, initiation of aspirin therapy should be withheld until the 13th week of gestation. However, current data indicates it can be continued until delivery without complication. Monitoring of these patients should include: warning signs and symptoms of bleeding, serial ultrasonography for fetal growth and fluid, serial fetal echocardiography, and neonatal evaluation for bleeding complications. Such clinical experience will add immensely to our understanding of the safety and efficacy of aspirin during pregnancy.
阿司匹林可能减轻或逆转病理过程的临床病症列表仍在不断扩充。然而，孕期使用阿司匹林确实存在一些已报道的风险，尽管部分研究结果相互矛盾。对婴儿的一些潜在不良影响也仍不明确。孕期使用低剂量阿司匹林的潜在益处（尽管前景乐观）仍处于试验阶段。美国和海外正在进行的大型临床试验正在评估低剂量阿司匹林预防先兆子痫和胎儿生长受限的有效性。截至目前对全球文献的综述描述了300多例使用低剂量阿司匹林的妊娠案例，均未发现重大不良影响的证据。然而，在出现更确凿的证据之前，强烈建议谨慎对待孕期随意使用任何剂量阿司匹林的行为。决定对复杂或可能复杂的患者长期使用阿司匹林进行治疗的临床医生必须持续深入研究这些母亲、胎儿和新生儿，并记录结果。由于担心孕早期的致畸作用，阿司匹林治疗应推迟至妊娠第13周开始。然而，目前的数据表明它可以持续至分娩而无并发症。对这些患者的监测应包括：出血的警示症状和体征、监测胎儿生长和羊水的系列超声检查、系列胎儿超声心动图检查以及对新生儿出血并发症的评估。此类临床经验将极大地增进我们对孕期阿司匹林安全性和有效性的理解。
