As reported today in the Dallas Morning News and Austin American Statesman, an article will be published in the September 2016 edition of Obstetrics and Gynecology showing a doubling in maternal deaths in Texas alone between 2010 and 2012. Some of these deaths are attributable to hypertensive disorders of pregnancy. Therefore, finding ways to prevent or lessen the severity of these disorders during prenatal care could have a tremendous impact in preventing morbidity and mortality associated with pregnancy.
The American College of Obstetricians and Gynecologists (ACOG) has recommended the use of low dose aspirin (usually 81mg per day) to those patients who have developed early-onset preeclampsia before 34 weeks in a prior pregnancy OR women who have developed preeclampsia in two or more prior pregnancies. This recommendation is now considered very restrictive, and would affect less than 1% of pregnant patients.
The US Preventive Special Task Force (USPSTF) published recommendations in 2014 based on several meta-analyses showing less restrictive recommendations for low dose ASA use that would lead to a decreased risk of developing a hypertensive disorder of pregnancy by anywhere from 10 to 23%; there would also be a decrease in the risk of preterm birth and intrauterine growth restriction of the fetus (IUGR).
We recommend low dose ASA (81mg) to the following obstetrical patients:
- Multifetal gestations
- Chronic hypertension
- Type 1 or 2 diabetes mellitus
- Renal disease
- Autoimmune diseases
- Prior history of preeclampsia
It is estimated that approximately 24% of obstetrical patients would be included in this treatment with these guidelines. The studies thus far did show a slight risk of placental abruption that apparently was not statistically significant. There were no reported increased risks for maternal postpartum hemorrhage or increased blood loss at delivery. One study showed no increased risk for newborn intracranial hemorrhage.
Other possible side effects would include maternal GI bleed and the exacerbation of asthma; these have not been encountered in the clinical trials performed to date.
Source: Barbieri, RL, OBG Management 2016 May; 28(5): 8-12