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By Executive Director Eleni Tsigas
How do you thoughtfully make a decision about medical matters? Especially when there is no clearly prescribed course of action supported by strong research, professional organizations, and universally accepted guidelines? For the majority of us who don't have medical degrees, it's easy to get overwhelmed by the amount of information we are expected to know as a consumer of health care. So, how can you discuss or evaluate potential preeclampsia interventions with your doctor?
Use the BRA formula:
B for Benefit: What's the potential benefit of trying to prevent preeclampsia with low dose aspirin/Lovenox/Atenolol/vitamin D or other interventions -- all with varying degrees of evidence? Could this intervention prevent preeclampsia, delay its onset, or lower your chances of getting it? And when you consider those benefits, make sure you understand the difference between having a 50 percent reduction and a reduction from 2 percent to 1 percent - they are identical! How scientific evidence is translated for you will impact how you perceive the benefit.
R for Risk: Everything comes with some risk, so it's important to press for a truthful and complete answer -- not only what side effects might happen if you choose a certain regimen, but the chances of that possibility. This, of course, is why prescription drugs come with really thin papers that fold out to the size of a US map, microscopically detailing all the potential side effects! This also applies to alternative therapies. Just because something is "natural" doesn't mean there is no risk. Explore the risks to you and your unborn baby. And while we're on the subject of risk, here's an article explaining how math can help you understand what "risk" really means.
You and your physician need to explore not only what the risks for a particular regimen are, but what attitudes, beliefs and values that you bring to this pregnancy. If pregnancy has made you reevaluate your willingness to take risks (as it does for many of us!) then which risks allow you to honor your values? You might be either more, or less, willing to run risks and only accurate information will let you assess how your medical care fits with your values.
A for Alternative: There is always something else you could do. It may be another therapeutic intervention or simply doing nothing. A good health care provider will appreciate that you have brought thoughtful questions to the exam room, but remember that your "internet research" may not make you an authority on the subject. Establish a close partnership with your provider that will allow you to weigh all of the options before making critical decisions about your health care.
For you as the patient there is a lot of information for you to absorb, especially with a high risk pregnancy, so keep in simple: just use your BRA formula when considering a course of a action: what are the Benefits, the Risks and the Alternatives?
Make sure you understand the answers, feel free to talk to others who have probably faced very similar situations on our Community Forum, and then feel confident you have been thoughtful and thorough in your medical decision.
International Society for the study of Hypertension in Pregnancy
October 23, 2016
San Paulo, Brazil