Why did my healthcare provider tell me to take low-dose aspirin?

Ever heard the phrase “the dose makes the poison”? Think of it this way: apples contain a teeny tiny amount of the chemical arsenic, which can be dangerous in large doses, but is harmless in the amount encountered in nature’s candy. 

The medical community has understood the risks associated with full-strength aspirin (325 mg or higher) use during pregnancy for years, and in fact, the FDA cautions pregnant women against taking full-strength aspirin at all during pregnancy. However, there’s quite a bit of evidence that low-dose aspirin (81 mg) can help prevent preeclampsia from developing in women at risk for preeclampsia, and that these benefits outweigh any risks that aspirin might introduce.

Who should take low-dose aspirin during pregnancy?

The American Congress of Obstetricians and Gynecologists (ACOG) have identified a number of risk factors for developing preeclampsia that make one a good candidate for low-dose aspirin. 

ACOG recommends low-dose aspirin therapy for those who have one or more of the following “high” risk factors:

  • History of preeclampsia, especially when accompanied by an adverse outcome
  • Multifetal gestation
  • Chronic hypertension
  • Type 1 or 2 diabetes
  • Renal disease
  • Autoimmune disease (systemic lupus erythematosus, antiphospholipid syndrome)

…or more than one of the following “moderate” risk factors: 

  • Nulliparity (first-time mom)
  • Obesity (BMI > 30)
  • Family history of preeclampsia (mother or sister)
  • Sociodemographic characteristics (African American race, low socioeconomic status)
  • Age 35 years or older
  • Personal history factors (e.g., low birthweight or small for gestational age, previous adverse outcome, more than 10-year pregnancy interval)

When should I start low-dose aspirin therapy?

ACOG and the Society for Maternal-Fetal Medicine recommend that candidates for low-dose aspirin begin their daily regimen between 12 and 28 weeks, and ideally before 16 weeks. Therapy should typically be continued daily until delivery.

How effective is low-dose aspirin?

According to one Cochrane Review, low-dose aspirin therapy might reduce one’s risk of developing preeclampsia by about 18%. More studies are certainly needed, but there’s plenty of evidence that low-dose aspirin is effective.

The bottom line

Preeclampsia is a serious pregnancy complication that can result in negative outcomes for both mother and baby. Taking low-dose aspirin doesn’t guarantee that you won’t develop preeclampsia, but it certainly lowers the risk. 

You should speak with your healthcare provider if you have any questions about low-dose aspirin, or your risk of developing preeclampsia.


Sources
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