Low-Dose Aspirin to Prevent Pregnancy-Induced Hypertensive Disease

To the Editor.  —The recent meta-analysis of aspirin and pregnancy-induced hypertension by Imperiale and Petrulis¹ caught our interest, and we examined this issue from the standpoint of clinical decision making. Since the meta-analysis included studies that were not randomized, not blinded, or used dipyridamole in addition to aspirin, we excluded data from those studies. Using data from the remaining studies that addressed cesarean sections,^2-4 we found that 5.6% of the aspirin group required cesarean sections, compared with 23.9% of the control group. With a maximum aspirin cost of $4.60 and a cost difference between cesarean and vaginal birth of $3014,⁵ the overall expected cost with aspirin is $173 per patient vs $720 without aspirin treatment. This indicates a significant cost saving by the reduction of cesarean births alone.Two concerns may alter this assessment. As mentioned in the meta-analysis, the indications for cesarean section were not uniformly