Low-Dose Aspirin in Pregnancy

  • By:  Emily Nobles, WHNP

Ask your provider if low-dose aspirin will ensure a healthier pregnancy.

Preeclampsia is a serious pregnancy-related condition that affects 3-4 percent of pregnancies in the United States. It is defined as new-onset hypertension (or high blood pressure) and organ damage that is diagnosed after 20 weeks of pregnancy. Preeclampsia can also occur right after delivery. The condition can affect a woman's brain, kidneys, liver, lungs, and platelet functioning. Newer research has led to a surge in guidelines from many different medical groups advocating the use of low-dose aspirin in the prevention of preeclampsia.

There is currently no test that can predict who will develop preeclampsia during pregnancy. There are also no prescription medications that have been developed specifically to prevent preeclampsia. However, studies dating back to the 1980s have been finding that a low-dose of aspirin has been shown to reduce the risk of preeclampsia in women at high risk of developing the condition.

In recent years, the evidence has become clearer, and both the American College of Obstetricians and Gynecologists (ACOG) and the United States Preventive Services Task Force (USPSTF) have issued guidelines recommending low-dose aspirin in the prevention of preeclampsia for specific populations of women. The USPSTF is a group of physicians that reviews scientific evidence to determine if preventive treatments are effective. This group is funded by a branch of the U.S. Department of Health and Human Services.

There is also evidence that taking low-dose aspirin is correlated with lower rates of associated conditions, including preterm birth (early delivery) and intrauterine growth restriction, which is a condition in which the baby is smaller than expected.

The studies have shown that aspirin reduced the risk of preeclampsia by 24 percent in clinical trials, according to the USPSTF. There was also reduction in the rate of preterm birth by 14 percent and reduction in risk of intrauterine growth restriction by 20 percent. Review of studies by the USPSTF also showed that the women who took aspirin to reduce risk of preeclampsia did not have any increased adverse outcomes.

The studies determined that the aspirin treatment did not cause any harm to the mother or the baby. There was not an increased risk in postpartum bleeding, complications with the placenta, stillbirth, or miscarriage seen in the women on the low-dose aspirin treatment.

A woman's obstetric provider will evaluate to see if she may be at risk of developing preeclampsia and if she is a candidate for aspirin therapy for preeclampsia prevention. There are a number of risk factors that help the provider to determine the patient's overall risk. High-risk factors include: a prior history of preeclampsia in a previous pregnancy, chronic hypertension, type 1 or type 2 diabetes, kidney disease, autoimmune diseases, such as lupus, and being pregnant with twins or greater.

If a woman has one or more of these risk factors, it is usually recommended that she receive low-dose aspirin during pregnancy. Moderate-risk factors include: being pregnant for the first time, obesity (or body mass index over 30), having a mother or sister who had preeclampsia, African-American race, age 35 or older, low socioeconomic status, and a personal history of having a baby with low birthweight or other pregnancy complications. If a woman has multiple moderate-risk factors, she may be a candidate to receive low-dose aspirin to reduce risk of preeclampsia. This would be determined by a woman's healthcare provider.

Because there is no test for preeclampsia, prevention is vital. At this time low-dose aspirin therapy is the best option for reducing this risk. If you are pregnant or planning a pregnancy and have any risk factors for preeclampsia, it is a good idea to talk to your obstetric provider to see if low-dose aspirin therapy would be recommended. You can work with your provider to determine when to start the medication and what dosage would be recommended.

Emily Nobles, WHNP, is a nurse practitioner at Atlantic Ob/Gyn located in Va. Beach and Chesapeake. For information, call 757-463-1234 or visit www.atlanticobgyn.com.

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