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Wednesday
Aug252010

Aspirin in Early Pregnancy May Prevent Preeclampsia 

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Guest post by Allie Sakowicz*

  

Preeclampsia and Intrauterine Fetal Growth Restriction (IUGR) are two common reasons for concern in the United States today, if correctly diagnosed.  But a new meta-analysis in the August 2010 issue of the ACOG’s Green Journal suggests that there may be a way to prevent both of these potentially dangerous conditions.  The solution could lie in simply taking a low-dose aspirin during early pregnancy.  

According to the study, preeclampsia affects approximately 2-5% of pregnancies and leads to over 100,000 deaths worldwide each year.  Even in developed countries such as the United States, it can cause complications for both mom and baby, such as stroke, renal and liver failure, and in extremely severe cases, death.  Preeclampsia increases the risk for IUGR, which has the potential of causing dangerous health consequences as well.  

This study looked at more than 11,000 mothers who fell into a category of moderate to high-risk for preeclampsia.  Women were assigned to receive low-dose aspirin or placebo (no treatment), which was began at either 16 weeks or less or 16 weeks or more.  Women who began low-dose aspirin treatment at 16 weeks or sooner saw a drop in the rate of preeclampsia, with only 9.3% of women being diagnosed with it it compared with 21.3% in the control group that did not receive treatment.  As for IUGR, low-dose aspirin began at 16 weeks or earlier was seen to have a 7% rate of the condition compared with 16.3% in the control group.  There were no significant differences seen in the group that began treatment after 16 weeks of gestation in either category.  Low-dose aspirin was also seen to drop rates of severe preeclampsia, hypertension and preterm birth.

One of the possible flaws with this study, however, is that only women who were at a moderate to high risk of preeclampsia were treated.  Even though low-dose aspirin did seem to have an effect in the rates of these condition in these women, it is unknown if it will work for low-risk mothers.

While more research may need to be done before low-dose aspirin becomes standard in prenatal care, it is an interesting concept and one that has the potential of saving many lives around the world if implemented.  

 

Have you ever treated a patient or been treated with aspirin for preeclampsia? What were the results? 

 

*Note from Allie: There are still about 3,162 days until I earn my medical degree (yes, I’ve counted).  Thus, nothing in this study should be taken as medical advice.  Please consult your healthcare provider regarding the suggestions made in this article.

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Reader Comments (10)

"One of the possible flaws with this study, however, is that only women who were at a moderate to high risk of preeclampsia were treated. Even though low-dose aspirin did seem to have an effect in the rates of these condition in these women, it is unknown if it will work for low-risk mothers."

A better way of putting that might be "it is unknown if the benefit of aspirin treatment to low-risk women will outweigh the risks".

August 25, 2010 | Unregistered CommenterQoB

"While more research may need to be done before low-dose aspirin becomes standard in prenatal care, it is an interesting concept and one that has the potential of saving many lives around the world if implemented."
What about eating a better diet instead of having to take aspirin, even at a low dose? (I really am ignorant about this, so please be kind in your answers!) Here in the US at least, we have acess to better foods than 3rd-world countries. Maybe this would be really good news for women without acess to good food, but not necessary as standard of care for those who can change their diets.

August 25, 2010 | Unregistered CommenterBecky

Becky, given what we know about pre-eclampsia (disclaimer: I am not a doctor or a medical researcher of any stripe, I'm a music school dropout with an Internet connection), prenatal nutrition appears to have very little to do with it. The cutting-edge research at the moment suggests that pre-e is actually caused very, very early in the pregnancy, by something called "incomplete trophoblastic invasion." Basically, when the blastocyst implants, it doesn't do so completely enough. (Dramatic oversimplification, of course.) To see the effect of this, take your fingers and interlace them together so that each finger is lying completely next to the other one, and look at the area of finger contact. Then slide them apart so they only overlap by one knuckle, and look at how much less area of contact there is. That's the incomplete invasion.

One of the reasons aspirin therapy was hypothesized to be helpful is that aspirin is a blood thinner -- it reduces the clotting action in the maternal blood supply. When clotting is suppressed, it gives the developing placenta a chance to establish more little vessels and increase the area of maternal-fetal interface. Of course, it also increases the risk of sub-chorionic hemorrhage and just plain bleeding, which is why more investigation needs to be done.

Anyway, at the end of the day, the issue that the aspirin therapy addresses is a really different one than the issue that prenatal maternal nutrition addresses.

Let me repeat that disclaimer: this is all gained from lay interpretation of online research articles. There is a significant chance that I'm wrong.

August 25, 2010 | Unregistered CommenterKathryn T.

I have had PE with all three of my successful pregnancies (the other two were early losses.) My non-expert understanding, based on reviewing a LOT of research, is similar to what Kathryn explained. PE is believed to be caused by problems with the placenta at implantation, which means for most women, whether or not they will get PE is already determined by the end of the 8th week of pregnancy.

My first two babies were mildly IUGR and continue to have growth problems to this day at age 7 and 3.5. The third time around, I was at even higher risk of PE because I was carrying twins. I started low dose aspirin at 12 weeks. I was diagnosed with pregnancy-induced hypertension at 22 weeks, PE at 31 weeks, and delivered at 36 weeks. Aspirin did not prevent PE in me, though it may have slowed things down considering the average time from diagnosis to delivery is 2 weeks and I lasted 14 (my previous children were born within 48 hours of diagnosis). BUT my twins were NOT IUGR. So possibly having my blood thinned meant more of it crossed the placenta, leading to better growth. At least, that's my armchair theory.

If I were to get pregnant again (unlikely), I would start LDA pre-conception or as soon as possible after the BFP.

August 25, 2010 | Unregistered CommenterJen

I look forward to hearing more about this interesting concept in the coming years. Aspirin may prove itself to be the lifesaver pill to all pregnant women out there who are at risk of preeclampsia. Thanks for this, Allie!

Shirley Grace
http://pregg.net

August 25, 2010 | Unregistered CommenterShirley Grace

So what happened to Dr. Brewer's findings? He had dramatic results in his clinic in reducing toxemia through good nutrition.

Wouldn't good nutrition before pregnancy affect how complete a trophoblastic implantation takes place? If not, what does affect it?
Wouldn't good nutrition affect how much good stuff got across even a limited supply line?

Could there be multiple causes? So that some women get a decently sized supply line, but poor materials going across it, some women get a decent supply line and good materials going across it, some have a limited supply line but good materials going across it, and some have both a limited supply line and limited materials supplied by diet to go across it. So for the latter set of women, diet wouild improve the outcome. And also for those who had such a poor diet that even with a decent supply line, the materials which had been getting across were so poor that the baby doesn't get much.

But for those for whom the laid down supply line is extremely limited, there would be a point where no matter how good the diet was, not much would get across.

So what causes some women to have incomplete trophoblastic invasion? If it isn't poor diet, and aspirin helps it, is it that they have a hyper-clotting disorder? Can't remember the name for this right off. But some people do tend to get blood clots more easily than others. Have they testing clotting times of women who get preecclampsia?

By the way, what is "lo-dose" aspirin therapy? The picture with this article is the standard 321 mg of aspirin. But I think they probably mean the 81 mg "baby" aspirin.

Susan Peterson

August 26, 2010 | Unregistered CommenterSusan Peterson

Wow, Kathryn, that's really interesting, I had always wondered about pre-e causes.

It's heartening to hear some good news. Pre-e is definitely one of the scariest/hardest complications to deal with.

August 26, 2010 | Unregistered Commenteremjaybee

I have had severe Preeclampsia twice now. It has nothing to do with diet. It actually has to do with the gene pool for that specific fetus. Basically there is a fight between the fathers genes and the mothers immune system at the time of implantation, that causes poor implantation of the placenta. So these supply lines are already laid, and the point of the aspirin is to make them as effective as possible. There are immune disorders and blood clotting disorders that can raise your risk of getting PE, but You can also be perfectly healthy, with good weight and diet, with no disorders and still get severe PE.

As far as the Brewers diet, this is harmful. This diet has been studied by real scientists and it has actually been proven to be more harmful to those at risk for preeclampisa. This is because he recommends that you increase the amount of protein in your diet, but then when/if you do get preeclampsia having extra protein in your system can be more harmful to your kidneys. Dr Brewer spouts all these fantastic stats about his diet, but if you actually research his numbers beyond his own website, the reason most of his "patients" did not get PE is because at the first signs of PE he would send them to other clinics so he could say he had no cases of PE, furthermore if someone did get PE after being on his diet, he basically explains this off by blaming the patient for not following the diet perfectly.

There may be many causes for the PE. Many different reasons that the placenta does not implant or form correctly, but all these reasons can still lead to the same outcome. PE has been traced back over 2000 years, so it would have very little to do with the external environment, but more with genes, immune systems, health of your blood vessels, and known disorders, or unknown for that fact. I am all for having a good diet, and environment for you baby, but this alone has proven over and over again to not be the cause of PE. A good diet is very important but it is not a cure or a way to prevent PE.

August 27, 2010 | Unregistered CommenterAmber

Preeclampsia cannot be controlled or manipulated by diet, period...there are MANY arguments about vitamin deficiencies, but different doctors will give you different answers. The asprin argument is pretty much the same. Some doctors say that it couldn't hurt to take it, so go for it, but it isn't a sure way to avoid it. I've seen many doctors over these issues and have asked more questions that I can count about it. If there was a sure way to avoid preeclampsia, it would be backed by all medical professionals.

August 27, 2010 | Unregistered Commenterthegirlfromflorida

I developed severe Pre-e with my daughter (Baby #1). With my son I was taking LDA from the BFP to 11 weeks, when I satrted having a little spotting I told my doc I wasn't comfortable continuing with the LDA, as even spotting in pregnancy wasn't normal for me. I believe that just the 8 weeks on LDA helped tremendously as it was the only thing I did differently in that pregnancy (besides taking Prenatals pre-conceptiopn). I wouldn't hesitate to do it again as long as no signs of bleeding were present.

August 31, 2010 | Unregistered CommenterMommy_Of_2
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