Aspirin to prevent PE?

[evansmom]

Hi all! Had my first ob visit yesterday. All went well, except the ultrasound showed a discrepancy between my LMP EDD and the size of the baby. We kinda figured this would be a problem since I was on birth control immediately prior to concieving. I need to go back for another ultrasound in 2 weeks to reconfirm the NEW EDD. Anyway, my question is, has anyone taken baby aspirin to prevent PE? Since I am a chronic hypertensive, my OB recommends taking one every night before bedtime. She says there has been a documented reduction in PE in those taking aspirin. Yet, I've heard it can cause miscarriage early n pregnancy. (I'm only 6 wks.) What do you think?
Lauren 27
DH Jeff
DS Evan 12/9/01 (pe@27 weeks)
EDD? 7/18/04

[momathelete]

Lauren,

I can only tell you my experience, I cannot tell you what you should do. My peri suggested baby aspirin also and they wanted me to take it immediately since they beleive there was less of a likelihood of clotting. The placenta forms/develops in the first trimester so they beleive that the anti-clotting agent of the 81mg aspirin will help prevent clotting. Aspirin may be a problem if you have problems with clotting in the first place. I ended up taking baby aspirin for my third pregnancy and I actually made it to 37 weeks. There are other factors that may have helped me get as far as I did, but I do not know how to isolate each one to say that it is what helped. Good luck with your pregnancy and I would try to follow what your doctor suggests. You may want to ask him about taking vitamin supplements too. I took tons, all under the supervision of my peri.



Michelle
mom to Cole Thomas -former 28.5 weeker (3-5-99, 3 lbs)due to HELLP and Madelaine Grace "Lainey" -former 29.5 (10-11-01, 3lbs 4oz)weeker due to Pre-E and had PIH with Elisabeth Rose (Ella) -37 weeker,born June 30th 2003 weighing 5 lbs 12 oz and beautiful.

[sarahedgcomb]

Hi Evansmom,

At 5 weeks, my doctor recommended I start taking 81mg of aspirin. At that appointment I had an ultrasound and everything with the fetus was normal - normal size, development, etc. A week and a half after starting the aspirin, I started to spot and eventually had a miscarriage. I had a few ultrasounds while I was spotting and we found out that the fetus had stopped growing at 5.5-6 weeks - right around the time I started the aspirin. The hard part was, the heart was still beating towards the end and there was nothing we could do except wait for the inevitable. I miscarried at 9, almost 10 weeks.

When I went for my 6 week checkup after the miscarriage, I saw another doctor in the practice and he was shocked that the first doctor started the aspirin so early. He said that if you're not already on aspirin prior to conception, they wait to have you start taking aspirin until week 11 or 12 - after the placenta has had a chance to attach itself successfully. I asked him if he thought the aspirin led to the miscarriage. He said that there's no way of knowing what actually led to the miscarriage, but that the aspirin certainly didn't help.

This is just my experience as well. I don't have chronic high blood pressure and all of my blood work came back normal (for clotting disorders, etc). You might want to ask your doctor what her opinion is on starting aspirin toward the end of the first trimester. I actually think that's when the studies that have involved taking low dose aspirin, start anyway (around week 12, but before week 14).

Good luck with your pregnancy.



Sarah

[joanne]

Hi Evans mum

With my first pregnancy I got PE at 28 weeks and had a caesarean at 31 weeks. With my second I started taking aspirin at 5 weeks and am now at 35 weeks with no problems so far.

Whether aspirin will benefit you has not been proven either way but your doctor can tell you if you are likely to benefit. Clearly it does with some women and with others it has no noticable efect.

The reason to take it in first term is that this is when the placenta forms and attaches to you. The effect of asprin is greatest at this time. By 2nd or 3rd trimestre some believe its too late to do any good. Certainly if you have any signs of a blood clotting disorder aspirin will help as would hepain.

I based my decision to take aspirin on doctor Ramon Hermida's research (Spain). Do an internet search on his name and aspirin in pregnancy to see what he says. There are other views which differ slightly or completely disagree. Most doctors believe that asprin in such small doses does not have any negative effects.

Unfortunately nothing is definite and so no one can guarantee how to completely avoid preeclampsia a second time around. What you must do is read as many views as possible and then discuss it with you doctor who will put them into context with your own circumstances. Do ths quickly now that you are aleady pregnant.

Whatever decision you make you should not say "if only I had...." afterwards. No one knows the cause or cure to this disease and we can only do what we think best until they are discovered.

There are other supplements you can take in addition to aspirin ( but they are intended to have a different effect). I took vitamin C and E. Other women on this site have taken calcium, omega 3 B vitamins. Whatever you wish to do, discuss it with doctor first.

Best of luck.




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

[sarahedgcomb]

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

[julie f]

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

[joanne]

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

[julie f]

Jo,

Thank you for those articles.

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

[sarahedgcomb]

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

[evansmom]

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