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Should you consider low-dose aspirin to reduce preeclampsia risk?

In this day and age of conflicting or inconsistent medical advice, it helps when important recommendations come together based on the evidence. That's the case with the American College of Obstetricians and Gynecologists (ACOG) and the U.S. Preventive Services Task Force (USPSTF).

In a 2016 practice advisory update, ACOG expands on previous recommendations issued by ACOG's Task Force on Hypertension in Pregnancy in November 2013. The new advisory expands its criteria for the use of aspirin in preventing preeclampsia, and brings it into alignment with USPSTF's clinical guideline published in September 2014.
In its clinical guideline based on a systemic evidence review, the USPSTF recommended the use of low-dose aspirin (81 mg/day) after 12 weeks of pregnancy in women at high-risk of preeclampsia. ACOG's updated practice advisory now expands its criteria for determining high-risk to be consistent with USPSTF's recommendations.
Women are considered to be at high-risk for preeclampsia if one or more of the following risk factors are present:

  •     History of preeclampsia, especially if accompanied by a poor outcome
  •     Multifetal gestation (pregnant with more than one baby)
  •     Chronic hypertension (high blood pressure)
  •     Diabetes (Type 1 or Type 2)
  •     Kidney disease
  •     Autoimmune disease

ACOG supports the recommendation to consider the use of low-dose aspirin (81 mg/day), initiated between 12 and 28 weeks of pregnancy, for the prevention of preeclampsia for women with these risk factors. Most experts go further to suggest that any benefits are realized when aspirin is started early by 16 weeks.
Are there risks to taking aspirin?
As part of its assessment, the USPSTF considered whether there was any potential harm to mom or baby. Its report found:

  •     No increase in infant loss, growth problems, or cognition harm to the baby;
  •     No statistically significant impact on risk of placental abruptions, postpartum hemorrhage (bleeding), or miscarriage to the mother;
  •     No differences in developmental outcomes of the infants up to age 18 months.

No studies have followed the offspring of preeclamptic women on aspirin beyond 18 months.
"The long-term effect of aspirin usage during preeclamptic pregnancies is actually one of the things we're collecting in The Preeclampsia Registry (," said Executive Director Eleni Tsigas about the Preeclampsia Foundation's patient registry. "We'd like to see how offspring of women who took aspirin during their pregnancies fare many years down the road.  There's no published data on this question."
If your doctor decides to put you on aspirin, he or she is doing so because they feel that the potential benefits greatly outweigh the minimal risks.
So what are the benefits? And for whom?
The main audience for the use of aspirin is women with the above risk factors. Taking aspirin does not guarantee that you will not develop preeclampsia. It is simply one more thing that women can do with relative safety to reduce their overall risk. The USPSTF review took into account approximately 30,000 randomized subjects, which found a 2% to 5% reduction in the rate of preeclampsia. Both the USPSTF and ACOG acknowledge that tools to assess individual risk for the condition and to identify subgroups of mothers most likely to benefit are still needed.
The USPSTF authors also agreed that preventing preeclampsia could reduce medical intervention in pregnancy and delivery. Preventing poor pregnancy outcomes could also reduce post-traumatic stress disorder and postpartum depression since preeclampsia is associated with poor maternal mental health outcomes.
What should you do?
If you are considering a pregnancy after experiencing preeclampsia, it is important to discuss your individual risk of preeclampsia with healthcare providers properly trained to evaluate them. Healthcare providers understand that you are eager to do what you can - safely and effectively - to decrease your risk of developing preeclampsia. Do not start an aspirin regimen without first discussing it with your healthcare provider.

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