Along with a daily prenatal vitamin, should pregnant women also take a low dose aspirin?
That’s what OB-GYNs are telling pregnant women at the University of Texas (UT) Health Science Center in Houston.
It’s part of their stepped-up program to prevent preeclampsia, the potentially life threatening pregnancy complication characterized by dangerously high blood pressure.
The low 81-milligram dosage, commonly referred to as “baby aspirin,” is a recommended treatment to help prevent preeclampsia in women who are at risk.
But last year, the UT doctors began prescribing it across the board.
Because they found some women slipped through the cracks during screening.
“One of the major drivers for why we started doing universal administration of low dose aspirin was because we had patients who were candidates for it and weren’t receiving it,” said Dr. Nana Ama E. Bentum, a maternal-fetal medicine specialist.
“In order to make sure we were not missing individuals, our department made a recommendation to give it to all our patients” she told.
“The majority of the patients we are seeing are in a high risk category.”
Recommended standard of care
The American College of Obstetrics and Gynecology (ACOG) says the rate of preeclampsia in the United States has increased 25 percent over the past two decades.
It is a leading cause of maternal and fetal illness and death.
Both the ACOG and the U.S. Preventive Services Task Force recommend low dose aspirin therapy for pregnant women who have at least one high risk factor or more than one moderate risk factor.
They define high risk as a previous history of preeclampsia, past multiple births, chronic hypertension, diabetes, kidney disease, or an autoimmune disease such as lupus.
- Moderate risk factors include:
- first time giving birth
- a family history of preeclampsia
- being of African descent
- low socioeconomic status
- age 35 years or older
- having birthed a low-weight baby
- a 10-year interval between pregnancies
- a previous adverse pregnancy outcome
The groups recommend pregnant women who are at risk be treated beginning at 12 weeks until delivery.
Should it be standard treatment?
“It’s a low-risk intervention. There are very few patients who can’t take aspirin, otherwise you will find it pretty safe,” Bentum said.
“Right now, universal dosing is not the official recommendation from ACOG and the U.S. Preventative Taskforce, but I think eventually it could be a recommendation.”
Dr. Liona Poon, a professor in the department of obstetrics and gynecology at the Chinese University of Hong Kong, said universal dosing might be a workable strategy in some low-income settings.
But in general, she would not recommend it.
That’s in part due to the risk of bleeding.
“Compliance is likely to be worse when aspirin is applied to the whole population than when recommended to a sub-population who has been counseled on risk,” Poon told.