When Felix Hoffmann, a German chemist, developed acetylsalicylic, more commonly known as aspirin in 1897, it was touted as a “wonder drug.” The pain-relieving qualities of this compound are well known and date back over 2000 years when ancient cultures used salicylic acid from tree bark to reduce fevers and ease pain. More recently, scientific research has expanded the reach of this powerful drug to include aspirin therapy for myriad conditions including reduction of cardiovascular disease risks, cancer prevention, and now treatment for preeclampsia in pregnancy. Preeclampsia is a serious complication of pregnancy, which affects approximately 3 to 5 percent of pregnancies.
The hallmark symptom of preeclampsia is hypertension or high blood pressure during pregnancy and swift delivery is usually the only treatment for this condition. Unfortunately, when preeclampsia develops too early in pregnancy, fetuses must be delivered far too soon. A premature birth come with its own set of problems, and around 15 percent of premature births are a result of preeclampsia. For many years, researchers have worked to study how and why preeclampsia affects certain women with mixed results.
Historically, close monitoring of a pregnant woman’s blood pressure as well as monitoring urine for signs of protein throughout pregnancy were the chief ways to predict if a woman may develop preeclampsia. More overt symptoms like severe headache, blurred vision, edema, or excessive swelling were also indicators that a woman may be experiencing preeclampsia. Prenatal visits were and continue to be the first line of defense in monitoring this serious condition.
To date, there is no good test to predict which women may develop preeclampsia and the precise cause is unknown. Scientists believe the etiology of the disease begins with the placenta and the formation of the surrounding uterine blood vessels that help sustain the developing fetus in the uterus. These narrow blood vessels react to the hormones associated with pregnancy and cause hypertension.
While it is difficult to predict, it is clear that some women are at increased risk of developing preeclampsia. These include women with a previous history of preeclampsia, either personal or family history. Women are also more likely to develop preeclampsia with their first pregnancy. Women who are over 40, obese, or pregnant with multiples are also at increased risk of developing preeclampsia, as well as women with certain medical conditions, including hypertension, kidney disease, lupus, and diabetes.
Women with any of these risk factors will require extra close monitoring throughout pregnancy to watch for signs of preeclampsia to prevent more serious complications to include placental abruption, poor blood flow to the placenta, HELLP syndrome, and eclampsia. All of these are extremely severe conditions, can be life-threatening to both mother and baby, and require prompt medical attention, most commonly, immediate delivery to prevent symptoms like heavy bleeding, severe headaches, organ damage, seizures, cardiovascular problems, and possible death. The ability to add a tool to the limited options currently available to possibly prevent preeclampsia is exciting indeed.
Several studies have recently shown the efficacy of giving high-risk women a regimen of low-dose aspirin to prevent the onset of preeclampsia. Likewise the studies show a decreased rate of premature births to those women treated with low-dose aspirin. The findings were significant enough that the U.S. Preventative Services Task Force issued a recommendation that women with an increased risk of developing preeclampsia should begin taking a low-dose aspirin daily beginning at their twelfth week of pregnancy. Low-dose aspirin is 81 mg per day and at one time was marketed as “baby aspirin.” Today, because of the increased use of low-dose aspirin in the treatment and prevention of cardiovascular disease, there are many products on the market.
Despite the availability of these medications without a prescription, aspirin is a potent drug which can have serious side effects. Aspirin can cause stomach upset and heartburn. Rare but possible side effects include internal bleeding. Additionally aspirin can interact with other medications one may be taking so it is always advisable to consult with your healthcare provider to discuss dosage and warning signs of possible serious side effects.
Prenatal care is so important for all pregnant women but especially for women who may be at risk for developing preeclampsia. Hopefully in the near future, researchers will discover the underlying causes of this often life-threatening condition of pregnancy and develop tests to predict and treat preeclampsia.
Dr. Hardy practices obstetrics and gynecology at Atlantic Ob/Gyn with locations in Va. Beach and Chesapeake. Please call 757-463-1234 or visit www.atlanticobgyn.com.