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Aspirin to prevent PE?

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Expand view Topic review: Aspirin to prevent PE?

Re : Aspirin to prevent PE?

Post by annegarrett » Fri Nov 28, 2003 04:53 am

Thanks for the interesting debate. You all will be happy to know you are not alone--the Medical Board has similar (and MORE heated) aspirin debates all the time. Our co-founder is not a big aspirin fan--as major studies have not shown it to very helpful but in smaller studies--there appears to be a group of women that low-dose aspirin helps.

What is key is that as you know--we are each different--I for one would clot so easily that my blood must be like sludge...other women (women with HELLP) would bleed out. I would be most concerned about a woman being put on LDA without a doctor checking her out and running a blood test for thrombophilias. What is clear is that the debate continues and there is no good answer to this damn problem. I wish there was.

Thanks for your input! I think we will have a good panel on this at the conference next summer! What do you all think?



Anne Garrett
Executive Director
Preeclampsia Foundation

Re : Aspirin to prevent PE?

Post by alysa » Fri Nov 28, 2003 04:17 am

Laura,
I am understanding more that low dose aspirin can be effective in many cases. I'm only commenting my concern mostly about aspirin in the third trimester as considered risky as I have learned it,- or possibly after the 36th week as there are other risks besides the one I mentioned of (possible increased risk of hemorrhage during delivery or bleeding probs. in newborn if taken 2 weeks near delivery is one I also read of -whether this is associated with the low dose therapy I do not know.)-This is only information I have learned of and definitely think people should double check this information if they have any doubts of my information or concerns -

I am starting to get more interested in learning more about aspirin in preg. - I can tell you that!

I don't think by fact that aspirin definitely can cause abruption or any type of seperation of the placenta; also I was stating that hypertension can be a possible risk as well that can cause aburptio placenta - (not aspirin causing hypertension etc.) [;)]
I don't mean to scare or worry anyone by my comments. I know I sound "anti-aspirin", as research goes that's usually always the best info to help to understand the benefits, or risks - if any, & for anyone to make their own decision. I do believe it can be a benefit to certain people in helping to prevent Pree. I also believe that every body reacts differently and always check and be under dr. supervision.
When first reading of low dose aspirin treatment I thought it is good to hear that something can help pree. My learning of any questionable risk- & decision not to take it, is only my personal choice; I'm not against medication when necessary - but personally opt for a natural approach as my first choice. I'm definitely not wanting to worry people who are taking it -maybe it is something that is good for you, and I do not want to interfere. - Especially I don't want to cause stress or worries because stress only increases BP, and that's the last thing I want to do.[:)]

It's good to see a medical report though, regarding aspirin. Thanks, it's helpful for me to see too.

Alysa

Chloe (4)
Isaiah (Feb 04)

Re : Aspirin to prevent PE?

Post by laura » Fri Nov 28, 2003 02:27 am

Alysa, I respect your right to not wish to take aspirin, and your right to talk about it, but I worry about women who are prescribed asprin by their doctors sitting around worrying about having an abruption. Aspirin does not cause hypertension, it is commonly used as a treatment for hypertension (of course, I have links to articles supporting this available upon request). And placental abruptions don't cause hypertension, they are caused by hypertension. (I wasn't clear on which factor you suggested caused hypertension) I found some information from a reputable source on the question.

"AHRQ is the Agency for Healthcare Research and Quality—the Nation's lead Federal agency for research on health care quality, costs, outcomes, and patient safety."

This governmental agency looked at ALL of the research associated with low dose aspirin and came to some conclusions for doctors, and they can be found at this site:
http://www.ahcpr.gov/clinic/lobrhigh.htm

Preeclampsia and Low-Dose Aspirin Therapy
Although findings from some clinical trials indicate that aspirin therapy is effective in reducing the risk of preeclampsia in pregnant women, other studies suggest that this therapy is associated with an increased risk of placental abruption. The PORT conducted several analyses to examine the data from these and other studies. The team's findings indicate that:

-There is an association with aspirin therapy compliance as measured by a maintained decrease in serum thromboxane levels, resulting in improved pregnancy outcomes such as less preeclampsia, less premature rupture of membranes, fewer preterm births, higher mean birthweight, and fewer small-for-gestational-age births.

-There appears to be no association between the risk of placental abruption and subsequent perinatal mortality and receiving preventive low-dose aspirin therapy. Biochemical Predictors of Preterm Birth PORT investigators, both in parallel and in collaboration with colleagues in NIH-funded studies examined biochemical markers or predictors of preterm birth. Findings from this work include:
Using data from serum samples of women in studies on risk factors for preterm delivery or term low birthweight, the PORT was able to conclude that the presence of interleukin-6 (IL-6) in the amniotic fluid is associated with an increase in spontaneous labor and may be useful as a predictor (or marker) for upper-genital-tract infection.
Other serum substances (e.g., plasma ferritin levels measured at 26 weeks' gestation) may be useful as predictors of spontaneous preterm birth.


Laura-28
DH Jack-30
Allie 5-13-98 (35 weeks-pre-e)
Baby Camille 4-17-03 (36 weeks- htn and oligo)
http://www.babiesonline.com/babies/c/camilleandallie/

Re : Aspirin to prevent PE?

Post by alysa » Fri Nov 28, 2003 08:21 am

Hi, I just wanted to add a reply. I do my own personal research on health and nutrition and have also been researching ways to help improve or alleviate some Pre E. or PIH symptoms. In my opinion, I feel "iffy" in regards to aspirin.

If you like, check the Ask the Experienced forum's section under "BP Very Healthy Life Style to Follow". I have put a lot of my own believed suggestions but check with your doctor about them; and always check with your doctor first (I also believe a second dr's. advice helpful) before deciding to take aspirin or other med's. (make double sure the particular antihypertension med's are okay in preg. & ask for the lab print out of any medication from the pharmacy as well as the pharmacist's opinion too. Ask questions if anything concerns you.) The more educated you are the better, and also can lessen your worries, help you know to a degree what to expect or make educated decisions with your doctor.

Regarding aspirin, one of the risks if taken late in preg. may be Abrupto Placentia-(the placenta abrupts or separates from the uterine wall; this can be a slight or more serious severe separation - both needing medical attention.- Hypertension is also a possible risk among other kinds of risk factors of this occurring as well) -This usually occurs late in pregnancy.

My only opinionated suggestion would be to research it's use/risks and definitely under medical supervision if you do take aspirin or any med. As aspirin has been shown to be helpful in regards to Pre.E or hypertension at a low dose, you should follow your doctor's advice (and second dr. opinion & other suggestive treatments to help as well or instead of). The use of aspirin can be risky in the 3rd trimester of pregnancy and it seems possible also risky in the very beginning as well.

As a note, miscarriage can happen from many causes, or even natural reasons. In my current pregnancy now, I feel lucky as I had a threatened miscarriage at week 7. The first trimester is a higher risk of miscarriage for any reason. (I'm 28 wks along now).

I hope this information is helpful.

Take care,

Alysa

Chloe (4)
Isaiah (Feb 04)

Re : Aspirin to prevent PE?

Post by evansmom » Thu Nov 27, 2003 08:08 am

Thank you for all of your advice -- especially all of the research material. My OB told me that I should take the aspirin @ bedtime since thats when the greatest reduction in PE was shown. I'm glad I now have the research to look at myself. So far I'm feeling great -- I have none of the symptoms I had even in early pregnancy with my son. I'm hoping that all the little things I'm doing (aspirin, eating a higher protein diet, anti-hypertensive drugs) will ward off the pe this time! Again, thank you for all of the caring advice.
Lauren

Re : Aspirin to prevent PE?

Post by sarahedgcomb » Wed Nov 26, 2003 11:37 am

Hi Joanne,

thanks for the articles. It seems likes there's conflicting opinions on whether aspirin works or not, and maybe timing is the key issue. I of course, had read about aspirin therapy and was pleased that my doctor had given me the "green light" to take it. I was even instructed to take it before I went to bed. In The Netherlands, you actually need a prescription for low dose aspirin. I wish I had done a little more research or had questioned the timing (weeks along in my pregnancy) or his actual opinon about why he was prescribing it. I think there's the opinion out there that "well, we don't know if it really works, but it doesn't seem to hurt" but I think for some women, it might do more harm than good.

I don't know what caused the miscarriage, but the miscariage itself was made a lot worse by the aspirin. I lost a lot of blood, had to have an emergency d&c and had to be hospitalized and given blood for the loss of blood. As you know aspirin affects your ability to clot.

So, I don't want to scare anyone. I think aspirin works - or doesn't
have horrible side effects for the majority of women out there. But, just like one would question their doctor about other measures he or she would take caring for a patient with a history of preeclampsia, aspirin therapy should also come under one's scrutiny as whether it is something the doctor thinks is crucial to one's positive pregnancy outcome, or if it's something they're just recommending or prescribing because "it doesn't seem to hurt".






Sarah

Re : Aspirin to prevent PE?

Post by julie f » Wed Nov 26, 2003 10:36 am

Jo,

Thank you for those articles.

Julie
Zachary James, 7/22/03-7/27/03, born at 26 weeks due to severe pe

Re : Aspirin to prevent PE?

Post by joanne » Wed Nov 26, 2003 09:58 am

Sarah

I attach references to an article and letters published in the British Medical Journal debating the issue and puting forward both sides and timing issues. Its not an answer but I hope it helps.

http://bmj.bmjjournals.com/cgi/content/full/316/7135/881/h

http://bmj.bmjjournals.com/cgi/content/full/319/7205/316

Jo

Jo 30
Sandy 33
Kit 31 weeks
EDD 12/28/03

Re : Aspirin to prevent PE?

Post by julie f » Wed Nov 26, 2003 09:36 am

Lauren,

I've had pre-pregnancy consults with two different peris and I have gotten two opinions on the aspirin... One says, take it after the heartbeat is established, the other said to start taking it when we start trying to conceive. So, they basically then told us it was our decision... I've asked in the "Ask The Experts" section but haven't heard back yet. At this point, I am leaning towards starting the aspirin upon trying to conceive but, will do a little more digging.

Good luck, I know it's a hard decision, we want to do the absolute right thing by our babies but, it's difficult to know what that is when the doctors don't even know.

Julie
Zachary James, 7/22/03-7/27/03, born at 26 weeks due to severe pe

Re : Aspirin to prevent PE?

Post by sarahedgcomb » Wed Nov 26, 2003 03:49 am

Hello again...

I did the search on yahoo and found Dr. Hermida's study. Here's what it says. FYI, the study was started when the women were 12-16 weeks pregnant.

"This study prospectively investigates the potential influence of low-dose aspirin on blood pressure in pregnant women who were at a higher risk of developing preeclampsia than that of the general obstetric population and who received aspirin at different times of the day according to their rest-activity cycle. A double-blind, randomized, controlled trial was conducted in 341 pregnant women (181 primipara) randomly assigned to 1 of 6 possible groups according to treatment (either placebo or aspirin, 100 mg/day, starting at 12 to 16 weeks of gestation) and the time of treatment: on awakening (time 1), 8 hours after awakening (time 2), or before bedtime (time 3). Blood pressure was automatically monitored for 48 consecutive hours every 4 weeks from the day of recruitment until delivery, as well as at puerperium. There was no effect of aspirin on blood pressure at time 1 (compared with placebo). A blood pressure reduction was highly statistically significant when aspirin was given at time 2 and, to a greater extent, at time 3 (mean reductions of 9.7/6.5 mm Hg in 24-hour mean for systolic/diastolic blood pressure at the time of delivery as compared with placebo given at bedtime). Differences in blood pressure among women receiving aspirin at different circadian times disappeared at puerperium (P>0.096). Results indicate a highly significant effect of aspirin on blood pressure that is markedly dependent on the time of aspirin administration with respect to the rest-activity cycle. Timed use of aspirin at low dose effectively contributes to blood pressure control in women at high risk for preeclampsia."


Sarah

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