In general, aspirin is not recommended for pregnant women because of an increased risk of bleeding for both the mother and fetus; however, on April 8, the US Preventive Services Task Force (USPSTF) recommended that certain high risk women should take low-dose aspirin during their pregnancy. The recommendation falls on the heels of a similar recommendation made by the American College of Obstetricians and Gynecologists (ACOG) last fall.
The recommendation applies to certain high risk women: those at risk for preeclampsia (toxemia), premature birth, and intrauterine growth restriction (IUGR; retarded intrauterine growth).The USPSTF recommends low-dose aspirin (81 mg/day), beginning after 12 weeks of pregnancy, for women who are at high risk for preeclampsia. This is a B recommendation, which means that the task force recommends the treatment because there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. The USPSTF is providing an opportunity for public comment on its recommendation until May 5. The task force notes that all public comments will be considered as the USPSTF develops its final recommendation.
The task force notes that its recommendation applies to pregnant women who are at high risk for preeclampsia and who do not have any signs or symptoms of the condition and have not experienced any health problems from using aspirin in the past. “Preeclampsia can cause serious health problems for both expectant mothers and their babies,” explained Task Force member Jessica Herzstein, MD, MPH. She added, “The good news is that pregnant women who are at high risk for developing preeclampsia can take a low dosage of aspirin daily to help to prevent the condition. This can result in better health outcomes for both the mother and the baby.” Task Force chair Michael L. LeFevre, MD, MSPH added, “Only a small percentage of pregnant women are at high risk for preeclampsia. Before taking aspirin, pregnant women should talk to their doctor or nurse to determine their risk and discuss if taking aspirin is right for them.”
Preeclampsia is a serious medical condition that affects all the organs of the body. For example, it affects the kidneys, resulting in protein in the urine. Other signs are headaches. Visual problems, rapid weight gain, and edema (swelling). It is tone of the most common complications of pregnancy; it affects approximately 4% of all pregnancies in the US. It can progress to eclampsia, in which seizures occur that can result in maternal death or stillbirth.
The cause of preeclampsia is unknown; however, the following risk factors are known:
- First pregnancy
- History of preeclampsia in a past pregnancy
- Chronic hypertension
- Age 35 or older
- Multiple pregnancy (i.e., twins or triplets)
- Certain medical conditions such as diabetes or kidney disease
- African American
- Certain immune disorders such as lupus or blood diseases
Treatment for preeclampsia is limited. The only real cure is to deliver the baby. Labor may occur spontaneously or be induced. Medication to control blood pressure and reduce the risk of seizures may be given during labor and for a period after delivery.