A simple preventive aspirin lowers risk of preeclampsia, a pregnancy danger

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A new advisory from a Federal panel finds strong evidence that low-dose aspirin reduces the risk of preeclampsia in women at risk of this worrisome pregnancy-related condition. Of course, this recommendation should be individualized for patients.

In Utero

The United States Preventive Services Task Force (USPSTF) has issued a new report after reviewing numerous studies on the dangerous pregnancy-related condition, preeclampsia. The studies they reviewed show strong evidence for a protective effect of low-dose aspirin for reducing the risk of preeclampsia among women at higher-than-average risk of this dangerous condition. Preeclampsia was formerly known as toxemia of pregnancy. It is a condition characterized by high blood pressure (hypertension) and protein in the urine (proteinuria). If not properly recognized and managed, preeclampsia can progress to eclampsia, which involves the development of very high blood pressure and seizures. Eclampsia is a medical-obstetrical emergency for both mother and baby and can be fatal; emergency c-section is required. Without treatment, it has been estimated that 1 out of 200 cases of preeclampsia progress to seizures (eclampsia).

Preeclampsia occurs after the 20th week of pregnancy and can even occur in the days following birth. Ninety percent of cases occur after the 34th week of gestation, and 5% occur after birth.

Preeclampsia occurs in about one out of every twenty pregnancies, but at a higher rate among women with certain risk factors: first-time pregnancies, teens, and women over 40 are at higher risk, as are women who have previously had the condition. There is no cure for preeclampsia other than delivery of the baby.

Women with mild preeclampsia may be monitored closely to allow the baby to mature. They may be given corticosteroids to help the baby's lungs mature and magnesium sulfate to prevent seizures. Sometimes, medications to lower blood pressure are needed.

Fetal complications of preeclampsia include risk of preterm delivery, oligohydramnios (low amniotic fluid levels), and slow fetal growth (IUGR, intra-uterine growth retardation). The exact cause of preeclampsia is not known. Maternal complications of preeclampsia and eclampsia includeliver andkidney failure, bleeding and clotting disorders.

While there is no known way to prevent preeclampsia, and the only definitive treatment is delivery of the baby, the current study is strongly supportive of starting any woman at higher risk of preeclampsia on low-dose aspirin, 60mg-150mg daily, from 18 weeks gestation until shortly before the expected delivery date (EDC in Ob. parlance). Of course, this recommendation needs to be individualized for each patient, thus is to be taken as an advisory, with possible contraindications to aspirin such as bleeding history or allergy considered.