What is the relationship between Acetylsalicylic acid (Aspirin) and Gestational Diabetes Mellitus (GDM)?

From the Guidelines

Aspirin is not specifically recommended for the treatment or prevention of Gestational Diabetes Mellitus (GDM), but it may be considered for pregnant individuals with GDM who are at high risk of preeclampsia. The primary focus for managing GDM should be on lifestyle modifications, including dietary changes and regular physical activity, alongside blood glucose monitoring and insulin therapy if necessary 1.

Key Considerations for GDM Management

• Lifestyle modifications are the cornerstone of GDM management, emphasizing dietary changes, regular physical activity, and blood glucose monitoring.
• Insulin therapy is typically the first-line treatment for achieving target blood glucose levels when lifestyle modifications are insufficient.
• Oral hypoglycemic agents may be considered in certain cases, but insulin remains the preferred choice due to its safety profile and effectiveness.

Aspirin Use in Pregnancy

• Low-dose aspirin (100-150 mg/day) is recommended for pregnant individuals with type 1 or type 2 diabetes to lower the risk of preeclampsia, starting at 12 to 16 weeks of gestation 1.
• For individuals with GDM, aspirin therapy may be considered if they have a single high-risk factor (such as chronic hypertension) or multiple moderate risk factors (like nulliparity, obesity, or age ≥35 years) for preeclampsia, as per the U.S. Preventive Services Task Force guidelines 1.

Prioritizing Morbidity, Mortality, and Quality of Life

• The management of GDM should prioritize reducing the risk of complications such as excessive fetal growth, birth trauma, neonatal hypoglycemia, and increased risk of cesarean delivery.
• Regular prenatal visits are crucial for monitoring both maternal and fetal health, adjusting the management plan as needed to optimize outcomes.

From the Research

Relationship Between Acetylsalicylic Acid (Aspirin) and Gestational Diabetes Mellitus (GDM)

• The relationship between aspirin and GDM is complex, with some studies suggesting that aspirin may not be effective in preventing preeclampsia in women with pre-existing diabetes 2, 3.
• A study published in 2022 found that low-dose aspirin use in women with pregestational diabetes may be associated with an increased risk of preeclampsia 4.
• Another study published in 2021 found that aspirin therapy was associated with an increased risk of postpartum haemorrhage (PPH) in women with pre-existing diabetes 3.
• A phase III multicentre double-blinded placebo-controlled randomised trial is currently investigating the role of early low-dose aspirin in diabetes, with results pending 5.
• A secondary analysis of two randomized controlled trials found that the efficacy of aspirin prophylaxis may differ by ethnicity and race, with a significant reduction in preeclampsia risk among non-Hispanic white women who received aspirin compared to placebo 6.

Aspirin Prophylaxis in Women with Pregestational Diabetes

• Current guidelines recommend low-dose aspirin for preeclampsia prophylaxis in all women with pregestational diabetes 4.
• However, studies have shown that aspirin may not be effective in preventing preeclampsia in women with pre-existing diabetes 2, 3.
• Aspirin therapy may be associated with an increased risk of PPH in women with pre-existing diabetes 3.

Ethnicity and Race Considerations

• The efficacy of aspirin prophylaxis may differ by ethnicity and race, with a significant reduction in preeclampsia risk among non-Hispanic white women who received aspirin compared to placebo 6.
• Stratification by ethnicity and race did not reveal a decreased incidence of preeclampsia for any of the subgroups in the High-Risk Aspirin trial 6.