A Federal Task Force Recommends that Pregnant Women at High Risk for Preeclampsia Take Low-Dose Aspirin Daily
Aspirin is generally not recommended during pregnancy, as it can lead to bleeding problems for both mother and baby. But for some women, the benefits of a daily low-dose aspirin after the first trimester may outweigh the risk.
Results from multiple clinical trials showed that using low-dose aspirin lowered the risk of preeclampsia in pregnant women at high risk for the condition (PMID: 24711050). Preeclampsia happens when a woman's blood pressure suddenly gets too high during pregnancy. If preeclampsia occurs during pregnancy, the only current cure is delivery of the fetus, often prematurely. In fact, preeclampsia is responsible for 15% of preterm births in the United States.
The clinical trials also found that low-dose aspirin reduced the risk for premature delivery and low birth weight of infants. Based on these findings, the U.S. Preventive Services Task Force (USPSTF) issued a recommendation that women at high risk for preeclampsia take a daily low-dose aspirin after 12 weeks of pregnancy to help prevent the condition from developing. The USPSTF recommendation mirrored the 2013 guidelines from the American College of Obstetricians and Gynecologists. Select a link below to learn more.
Preeclampsia affects 3% to 5% of pregnancies in the United States each year and is a leading cause of maternal and neonatal morbidity/mortality. Women may be at higher risk for preeclampsia if they:
- Had preeclampsia in a previous pregnancy, especially if they delivered prematurely
- Are obese
- Are younger than age 20 or older than 35
- Are carrying twins or multiples
- Had high blood pressure or kidney disease before getting pregnant
- Are African American
- Have a family history of preeclampsia
- Have certain health conditions, such as diabetes, lupus, or polycystic ovary syndrome (PCOS)
However, it can be difficult to predict if a woman will develop preeclampsia. Pregnant women with normal blood pressure at 20 weeks of pregnancy can suddenly develop the symptoms, which include high blood pressure, increased swelling, and protein in the urine. Much of the time, preeclampsia has no visible symptoms.
For this reason, it is important for all pregnant women to get regular prenatal care. This will allow their health care provider to monitor their health closely and determine if a daily aspirin is needed.
The NICHD has supported research on preeclampsia for decades. Scientists seek to understand the causes of preeclampsia and how best to prevent and treat the condition. Some of the current research led and supported by the NICHD on preeclampsia includes, but is not limited to, the following:
- A method to triage and monitor the patient with suspected preeclampsia. Researchers in NICHD's Program in Perinatal Research and Obstetrics(PPRO) have developed a novel classification system by examining biomarkers in the plasma of patients with preeclampsia to identify those at risk for preterm delivery or adverse maternal/neonatal outcome. The PPRO has identified biomarkers that can be measured in maternal blood in the midtrimester that can be used to predict preterm and term preeclampsia.
- Treatments to lower blood pressure during pregnancy. Researchers are studying corin, a newly discovered molecule that regulates blood pressure. In previous studies on mice, those that lacked corin developed high blood pressure and high levels of protein in the urine during pregnancy. This suggests that corin may play a key role in preventing high blood pressure during pregnancy. Researchers hope to develop treatments using corin to help prevent preeclampsia.
- The use of medications other than aspirin to lower the risk of developing preeclampsia. Researchers are also studying whether daily use of pravastatin and other statins, which are typically used to lower and manage cholesterol levels, can benefit women at high risk for preeclampsia.
- Potential treatment of preeclampsia. Researchers are working to develop a new and safe therapy for preeclampsia. Pregnant women with preeclampsia have higher levels of a certain protein in their blood. In this study, researchers will filter patients' blood to remove these proteins, using a therapy similar to dialysis for kidney patients. Researchers hope this treatment will reverse symptoms of preeclampsia and prolong pregnancy.
- The effect of obesity on preeclampsia. Current studies on the impact of obesity may tell researchers if factors contributing to obesity are related to the development of preeclampsia. Researchers are also evaluating whether these same factors contribute to cardiovascular conditions in non-pregnant women with a history of preeclampsia.
These are just a few of the Institute's ongoing projects related to preeclampsia. Read more about NICHD research on preeclampsia.
- Henderson, J. T., Whitlock, E. P., O'Connor, E., Senger, C. A., Thompson, J. H., & Rowland, M. G. (2014). Low-dose aspirin for prevention of morbidity and mortality from preeclampsia: A systematic evidence review for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 160(10), 695–703. (PMID: 24711050)
- U.S. Preventive Services Task Force. (2014). Low-dose aspirin for the prevention of morbidity and mortality from preeclampsia. (Update in Progress)
- American College of Obstetricians and Gynecologists. (2013). Hypertension in pregnancy.
- A to Z Topics:
- Division of Extramural Research: Obstetric and Pediatric Pharmacology and Therapeutics Branch
- Division of Extramural Research: Pregnancy and Perinatology Branch
- Division of Intramural Population Health Research
- Division Annual Report 2013 (PDF - 1.1 MB)
- Previous NICHD Spotlights on Preeeclampsia:
- NICHD News Releases Related to Preeclampsia
Originally Posted: August 25, 2014