April 9, 2014
News Review From Harvard Medical School -- Aspirin Recommended to Prevent Preeclampsia
A daily low-dose aspirin may help prevent preeclampsia in women at high risk of this dangerous pregnancy problem, an expert group says. The new advice comes from the U.S. Preventive Services Task Force. This independent group provides guidance to doctors and the government on preventive care. Preeclampsia causes high blood pressure, swelling and protein in the urine. It can decrease the blood supply to the fetus and to the mother's organs. The fetus may grow slowly. Early delivery may be required to prevent stroke in the mother. Preeclampsia can lead to eclampsia, which produces seizures. Preeclampsia is more likely for women who had high blood pressure or diabetes before pregnancy and for those pregnant with twins or more. For these women and some others, the task force recommends a daily baby aspirin (81 milligrams) starting in the second trimester. The advice was based on a review of research. On average, studies showed a 24% lower risk of preeclampsia with aspirin use. It reduced the chances of preterm birth by 14% and slow growth of the fetus by 20%. The journal Annals of Internal Medicine published the task force report. HealthDay News wrote about it April 7.
By Reena L. Pande, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Many of us imagine that pregnancy should always be simple and straightforward. But problems can indeed arise. And doctors and researchers continue to search for simple ways to prevent these problems during pregnancy.
One condition that can occur during pregnancy is preeclampsia. Women typically develop preeclampsia after 20 weeks of pregnancy. The signs and symptoms include:
- High blood pressure
- Protein in the urine
- Swelling (in the legs, hands or face)
- Vision changes
- Nausea and abdominal pain
- Difficult breathing
Preeclampsia can be a dangerous condition for mom and baby, especially if it leads to seizures. At that point, the condition is called eclampsia.
Some of the dangers of preeclampsia include:
- Preterm delivery (partly because the only cure for preeclampsia is to deliver the baby)
- Stroke or other organ damage in the mother
- Low birth weight in the baby
- Pregnancy loss
We still don't know why preeclampsia develops in the first place. So doctors and researchers have struggled to find ways to prevent it. However, new guidelines may be changing that. The guidelines come from the U.S. Preventive Services Task Force, which makes recommendations about preventive medical care.
The guidelines say that taking a baby aspirin (81 milligrams) once a day may reduce the odds of developing preeclampsia by about 24%. And they suggest that for women who already have preeclampsia, aspirin may lower the chance of problems such as preterm birth or low birth weight.
What Changes Can I Make Now?
1. Understand what factors increase the risk of developing preeclampsia.
Preeclampsia affects about 4% of pregnancies. Strong risk factors include:
- Prior history of preeclampsia -- If you've had it before, you are more likely to have it again.
- High blood pressure, diabetes or kidney disease before pregnancy.
- Being pregnant with twins, triplets or more.
Other factors that increase risk include:
- Older age (above 35) or younger age (under 15)
- African-American or Hispanic race/ethnicity
- Family history of preeclampsia
- First pregnancy
2. Talk to your health care professional. There are risks and benefits to taking any medicine, especially during pregnancy. Be sure to talk to your doctor before starting any new medicines, including aspirin.
3. Stay healthy during pregnancy. There are many important ways to keep healthy during pregnancy.
- Maintain a healthy and appropriate body weight.
- Remain physically active.
- Don't smoke.
- Eat a well-balanced diet.
4. Stay healthy after pregnancy. Many women don't realize that complications that arise during pregnancy can lead to health problems later in life. These include high blood pressure and heart disease. Preeclampsia may increase your risk of future problems, so it's important to take care of your health after pregnancy.
What Can I Expect Looking to the Future?
Researchers are learning more and more about why women develop preeclampsia. For example, there are clues that it may arise because of a problem with the placenta. The odds of developing this problem might be influenced by the mother's or father's genes or immune system. Understanding what lies behind preeclampsia will allow for development of better treatments in the future.