U.S. Experts Say: Give Aspirin to All Pregnant Women at Risk of Preeclampsia

Forbes: A panel of medical experts from the United States Preventative Task Force (USPTF) now recommends that women at high risk for a pregnancy-related condition known as preeclampsia take low dose aspirin after 12 weeks of pregnancy.

The panel found that those who are at a high risk of developing the condition can reduce their risk of developing preeclampsia by as much as 24% by adhering to the recommendation to take aspirin after the 12th week of pregnancy.

Aspirin also reduced the risk of developing stunted growth of the fetus by up to 20% and preterm birth as much as 14%, according to results of the task force.

Findings of the panel were published online in the Annals of Internal MedicineSeptember 8th.

Preeclampsia is a complex pathological condition that occurs in some women after 20 weeks, characterized by elevated blood pressure (>140/90), excess protein found in the urine, along with swelling or edema of the lower extremities.  The exact cause of the condition is unknown at this time, but is believed to be immunologic in origin.

Preeclampsia develops in up to 8% of all pregnancies, and 4% of all pregnant women in the US may develop this condition.  It is implicated in up to 12 % of all maternal deaths in the US, and is responsible for up to  15 % of all preterm births.

Women at high risk for preeclampsia include those with a history of elevated blood pressure, diabetes, or any previous history of autoimmune disease such as lupus, scleroderma, as well as a history of kidney disease.

Patients who are pregnant with twins or multiples, and who have had a history of preeclampsia with a previous pregnancy also run an elevated risk to develop the condition again.

In 1996, the task force evaluated data regarding aspirin’s ability to reduce the risk for developing preeclampsia—however, the evidence was not definitive, and as a result, no recommendation was made to recommend aspirin for women at high risk.

However, since 1996, there have been many high quality trials that clearly and consistently demonstrate aspirin’s benefit for women at high risk for preeclampsia.

As a result, the current recommendation is for women who are at high risk to develop preeclampsia to begin taking a low dose aspirin (81 mg) after the 12 week of pregnancy. Women with a history of bleeding gastric ulcers should not take aspirin, along with those who may have other contraindications to aspirin therapy.

“Preeclampsia is one of the major causes of maternal mortality and also premature delivery,” said Dr. Jennifer Wu, an OB/GYN physician at Lenox Hill Hospital in New York City. “With no real tools for accurate prediction of those pregnant women who will develop preeclampsia, a method of prevention for those at risk is very important.”

“All women at high risk for preeclampsia and many of those with moderate risk should be treated with low dose aspirin starting in the second trimester,” added Wu.

It is unclear exactly why aspirin is beneficial for prevention of preeclampsia; however, data from multiple high quality studies supports the use of such therapy, as the benefits clearly outweigh risks.