by Dr. Janet Matuszek
The US Preventative Services Task Force (USPSTF) has recently recommended that all pregnant women who have one major risk factor for developing preeclampsia be treated with low-dose aspirin which is 81mg daily which is a baby aspirin. These are listed below:
– Multifetal gestations (twins, triplets)
– Chronic hypertension (having high blood pressure before pregnancy started)
– Type 1 or 2 diabetes mellitus (not gestational diabetes)
-Patients with renal (kidney) disease, autoimmune diseases (like Lupus)
-Prior history of having preeclampsia with a previous pregnancy.
The USPSTF also recommends that if a person who is pregnant with multiple moderate risk factors also be treated with the low-dose aspirin. This risks are listed below:
-First pregnancy
-Obesity defined as body mass index (BMI) > 30
-Family history of a mom or sister having preeclampsia
-Sociodemographic risks factors (low socioeconomic status, African-American race)
This recommendation is different than the current recommendation from the American College of Obstetrics and Gynecology (ACOG) which recommends treatment with low-dose aspirin only in women who have a personal history of early-onset preeclampsia with delivery before 34 weeks gestation OR in women who have had preeclampsia in 2 or more pregnancies. The problem is that this recommendation only affects 0.35% of pregnancies; whereas, the recommendation from the USPSTF affects 24% of all pregnant women.
The USPSTF recommendations come from multiple clinical trials involving over 35,000 women. The risk reduction in preeclampsia was small approximately 10-23% decreased risk but since preeclampsia affects a lot of women, the USPSTF believes this will have beneficial effects that are real. In addition, the study also showed a decrease risk of preterm delivery and fetal growth restriction with the low-dose aspirin regimen. However, this USPSTF recommendation is not for patients who have had a previous preterm birth or previous baby affected with growth restriction. This study was only looking at prevention of preeclampsia.
The appropriate dose in the studies was 81mg daily starting after 12 weeks and before 16 weeks. So basically starting after the end of the first trimester.
Maternal side effects appeared to be minimal in these large studies. Worries were that increased gastrointestinal bleeding and exacerbation of asthma would be present but in the trials involved in this preeclampsia reduction study showed these risks were not significantly increased. In addition, the USPSTF showed low-dose aspirin was associated with no significant perinatal (placental abruption) or neonatal harm (intracranial bleeding).
So…..in summary, low dose baby aspirin in the appropriate patient does seem to lower the risks of preeclampsia. So yes, these select patients should take a low dose baby aspirin starting after 12 weeks of pregnancy. If you have any questions or feel you would benefit from this new recommendation, please ask one of our providers for further information.
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