Pregnant women's risk of preeclampsia drops with daily baby aspirin: pictures
Bridget Desmux (center) and her husband Jeffrey love to have a large, active family. "Kids always go for things, fly over and over – it's not boring," she laughs. Mila (far left) has a passion for gymnastics. Her siblings are the (left) twin Mackenzie and Jeremiah, Jonathan and Jeffrey.
Ryan Kellman / NPR
Ryan Kellman / NPR
Bridget Desmux was surprised when OB-GYN recommended low-dose aspirin at her first prenatal appointment last spring. She knew about the daily intake of low-dose aspirin in people recovering from a heart attack or stroke. But for pregnant women?
In past pregnancy, Desmux developed preeclampsia, a potentially serious complication involving high blood pressure. A small amount of daily aspirin, it turns out, can significantly reduce the risk of preeclampsia in pregnancy. It is currently recommended for many pregnant women from two influential groups ̵
1; the American College of Obstetric Gynecologists and the US Preventive Services Specialized Group, an independent expert committee commissioned by the federal government.
The challenge, according to some OB-GYNs, is to give the word to women who are at risk that a low dose of aspirin is something that may be helpful to them. In this way, Desmux and her husband Jeffrey were lucky to hear about it early in their pregnancy.
She says that her doctor "explained to us that due to my age and the fact that I have a history of pre-eclampsia, I would be advised to take aspirin. Just be careful about maintaining the flow of nutrients and oxygen and everything to the baby and helping it continue to thrive and grow. "
As an older mother who has experienced pre-eclampsia in the past, Desmukes is considered to be at high risk for recurrent conditions. She is a nurse practicing and knows the risks, so she agreed with her OB-GYN that accepting single aspirin for a baby is a good idea. "Just be careful," she says, "to maintain the flow of nutrients and oxygen … to the baby."
Ryan Kellman / NPR
Ryan Kellman / NPR
Desmux says she was hesitant at first. A nurse by education, she knows that any drug can have side effects, and says she prefers a "holistic" approach to her own health. But she also knows the risks of pre-eclampsia and how it can be fatal – a leading cause of high maternal mortality in the US, and as a black woman, Desmux's risk of dying at birth is increased; maternal mortality among black women in the US is about three times higher than that of white women.
She did some research, thought about it and decided to take aspirin. It is coming in November and so far everything is going well – there are no signs of hypertension.
How it works
The cause of preeclampsia in a pregnant woman is not yet known, but the mechanism of danger is clear: Her blood vessels contract, which means, among other things, that the blood does not it can easily flow to the kidneys, brain or uterus. Telltale's signs include a terrible headache and swollen hands and feet.
"What aspirin does is relax the blood vessels, [which] it lowers blood pressure, but it also improves blood flow to the baby, kidneys and brain, reducing the likelihood of a woman having any pregnancy complications, would affect either her or her baby, "says Dr. Jody Abbott, OB-GYN, who specializes in high-risk pregnancy treatment at the Boston Medical Center and is also an associate professor at the University of Boston School of Medicine.  The last person you expect to die at birth “/>
Prenatal aspirin may reduce preeclampsia risk by 24%, according to a comprehensive review of USPSTF scientific evidence in 2014. This guide describes the harms of low aspirin intake
"Proved to be very safe," says Dr. Nyia Noel, who is an abbott contributor to the Prenatal Aspirin Project – a BMC initiative created to increase the implementation of the recommendations of the Working Party. "Things that people worry about – such as bleeding during pregnancy or something called placental disruption, which is early placental discharges – have not been shown to increase in women with low aspirin."
Now this is not is like taking aspirin for pain relief – it's a much higher dose, usually 325 mg per pill and one or two pills every four to six hours. In contrast, low-dose aspirin tablets are about 81 mg. They are usually inexpensive and can be prescribed – often covered by insurance – or bought over the counter.
Noel talks about her, saying that the benefits of prenatal aspirin are personal to women. African-American women are more likely than white women to develop pre-eclampsia and are more likely to die from it.
"This topic is very important to me – as a black woman, but also as a black gynecologist in the care of women of color every day," she says. "I experienced what felt like a degree of separation between myself and women, just like me, who died or almost died from preeclampsia." Noel says. "So I really feel that aspirin is not the only thing, but it is a step. Do women really need to feel empowered to talk to their suppliers about this.
Aspirin comes in a prenatal vitamin near you?
Any woman who is pregnant with twins or triplets or with diabetes or hypertension or who has had preeclampsia before is considered a high risk of the condition and should speak with her doctor about taking low-dose aspirin, Abb says
Beyond this group of high risk characteristics, there are medium risk factors ri – like pregnancy with a first baby, or obesity, or over 35, or an African American The presence of two or more of these characteristics means that low-dose aspirin should also be considered for you, the guidelines state.
Abbott he says, when you add women in all these categories, it equals a whole bunch of people. "" Eighty-six percent of our patients [at Boston Medical Center] will be eligible for aspirin based on those criteria, "says Abbott. "When you look at a figure like 86%, you can see why I would be in favor – as a public health initiative – of all pregnant women getting it."
As Abbott sees, checking all of these risk factors means someone who can benefit will inevitably be missed. And because she doesn't see the significant disadvantages of low-dose aspirin, she thinks she should just go to everyone who is pregnant.
"My suspicion – if I have to speculate for 10 years – is that you will be able to buy, included in your prenatal vitamin, a low dose of aspirin," she says.
The need for universal research
But not everyone is convinced – at least at this point – that any pregnant woman should take aspirin, with Count Carina Davidson among them, who is a senior vice president for research at Northwell Health and a member of the Special Services Group on Preventive Services of the United States, which reviewed the evidence on this matter in 2014.
It is said that aspirin prevents the harmful effects of pre-eclampsia and many hypertensive pregnancy disorders, "she says." For those at risk, we absolutely want both clinicians and patients to know, that they should discuss whether aspirin is right for them to help them minimize their exposure – and their babies' exposure – to those damaging effects. "
Bridget Desmux shares time with her son Jonathan on the front porch of the home them in Washington, Round Colombia, while his brother Jeffrey makes wheeled bicycles. The boys say they are very excited that the new baby will be a boy too.
Ryan Kellman / NPR
Ryan Kellman / NPR
However, the current recommendations of this group stop recommending prenatal aspirin to all.
"We have a very specific mandate, which is that we make evidence-based recommendations," Davidson says. "When we looked at 2014, we found little evidence that there was a benefit to the low-risk population." In other words, it should be beneficial to take aspirin for women who are currently at low risk of developing preeclampsia – not just the lack of significant harm.
In June, the Working Group began looking to see if new research had been done since 2014, which would make the group want to change its prenatal aspirin guidelines, but this review would not be completed in a few years.
Dr. Google and Other Barriers
The Prenatal Aspirin Project at Boston Medical Center began in 2017 to clarify the benefit of low-dose aspirin in pregnant women for eligible women and to study the barriers to the task Force recommendations.
Through focus groups, project managers found that most of their patients had never heard of preeclampsia. "We also found that they were told that it was not safe to take medication during pregnancy or that aspirin could be dangerous and you should not take it," Abbott says. "[Or they would] go to the pharmacy and the pharmacist will tell them that aspirin is dangerous in pregnancy."
Abbot believes pharmacists may not have been aware of prenatal aspirin recommendations from the last few years or may have thought about
the team of the prenatal aspirin project came to large drugstores – CVS, Walgreens and Walmart – and prompted them to remove warnings for aspirin reborn prescriptions. After some patients told them "I have a prescription, but I'll go to Google before I pick it up," project team members have also worked to raise their ratings on Google, so project tips will appear over information that could be
Eliminating those barriers is important, says Abbott. "Everybody deserves a good baby and a healthy mother, and we're failing right now," she says. "This is indeed an opportunity for all women – but especially women of color – to have the opportunity to regain some power over their ability to have a healthy pregnancy and healthy children."
Of course, low-dose aspirin is not the only response to the high maternal mortality rate in the country. "There are certainly other things that need to be addressed – structural barriers, structural racism related to differences that exist," Noel says.
This little pill won't fix all that. Noel says there is great potential to reduce the incidence of preeclampsia, a condition that kills many women.