Objective: To investigate the effects of aspirin on the distribution of birthweight and its impact on the rates of large-for-gestational age (LGA) neonates. Design: Secondary analysis of the Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-based Preeclampsia Prevention (ASPRE) trial. Setting: Thirteen hospitals in England, Spain, Belgium, Greece, Italy, and Israel. Population: Participants of the ASPRE trial at increased risk of preterm pre-eclampsia (PE) who had a live birth. Methods: We compared the birthweight distributions and the rates of LGA neonates between the trial groups. Analyses were stratified according to the presence of pre-existing diabetes mellitus and the development of pre-eclampsia, and logistic regression was used to investigate independent predictors of LGA neonates. Main Outcome Measures: Birthweight distribution and rate of LGA neonates. Results: Among 1,571 singleton, live neonates (777 from the aspirin group and 794 from the placebo group), aspirin was associated with a shift in birthweight from below 2,500 to between 2,500 and 4,000 grams, and birthweight percentile from below the 25 th to between the 25 th and 75 th percentiles, with no significant increase in LGA neonates (5.5% vs. 6.2%, p=0.667). Logistic regression demonstrated a significant interaction between treatment and pre-existing diabetes (p-value 0.034), and a positive association between maternal weight and LGA neonates (adjusted odds ratio 1.040, 95% confidence interval 1.030 – 1.051, p<0.001). Conclusions: Aspirin use is associated with increased birthweight without increasing the rate of LGA neonates. Among women with pre-existing diabetes, however, aspirin may lead to a higher rate of LGA neonates.

Background: Medical literature supports planned caesarean delivery (CD) for breech presentation at term, due to observed reductions in neonatal morbidity and mortality when compared to normal vaginal delivery (NVD). Objectives: We want to compare perinatal outcomes of singleton pregnancies with breech presentation at term in two University hospitals. One where the option of NVD is routinely offered (Protocol I), a second where these babies are routinely delivered by CD (Protocol II). Study design: A retrospective matched cohort-study was conducted between January 2015 and May 2021. We included singleton pregnancies with frank or complete breech presentations, delivered from 34+0 weeks gestation with known outcomes. Primary outcomes were a composite of adverse obstetrical outcomes (CAOO) and a composite of neonatal adverse outcomes (CANO). Results: 1079 women were eligible for analysis. After matching for possible confounding factors, the final analysis was conducted in 257 patients in each group. CAOO was similar in the two groups (24.1% versus 24.5%, p-value = 1.000), CANO was significantly higher in patients of Protocol I (17.9% versus 1.2%, p-value < 0.001). No neonatal death or birth trauma were reported in either group. The rates of NICU admission (4.3% vs 0.4%; p=0.004), respiratory distress at birth (17.5% vs 1.2%; p<0.001) and APGAR scores <7 after 5 minutes (5.8% vs 0.4%; p<0.001) were significantly higher for Protocol I. Conclusion: Short-term, non-severe adverse neonatal outcomes are significantly increased in the Protocol I group. These must be balanced against the possible negative impacts of caesarean birth on long-term infant and maternal health.