Even if aspirin isn't commonly used, everyone has certainly heard of it.
A while ago, The Lancet published an article about how low-dose aspirin can prevent premature birth.
The study included 11,976 women aged 14-40, divided into a low-dose aspirin group (receiving 81 mg of aspirin daily during weeks 6-13 of pregnancy) and a no-aspirin group.
The final study showed that receiving low-dose aspirin between 6 and 13 weeks of gestation can reduce the risk of preterm birth at 37 weeks and adverse neonatal reactions.
In fact, the effects of low-dose aspirin on premature birth have always been controversial, and this article undoubtedly adds strong evidence to this debate.
However, whether aspirin can prevent premature birth requires further scientific trials to prove.
Currently, the guidelines recommend against using low-dose aspirin to prevent spontaneous preterm birth in the absence of preeclampsia risk factors.
Therefore, whether aspirin can be used to prevent premature birth remains to be seen.
Now let's talk about the established indications for aspirin during pregnancy—prevention of preeclampsia.
What is preeclampsia?
Preeclampsia is a pregnancy-specific condition characterized by elevated blood pressure, proteinuria, and involvement of other organs throughout the body. It is a leading cause of maternal mortality worldwide, posing a serious threat to maternal and infant health.
Preeclampsia can also cause fatal complications such as placental abruption, acute renal failure, intracranial hemorrhage, and disseminated intravascular coagulation.
Therefore, timely and appropriate use of aspirin to prevent and delay preeclampsia is particularly important. Of course, its safety should be discussed first.
Is it safe to use aspirin during pregnancy?
Let's see what the guidelines say:
2014 USPSTF Recommendation Statement on Low-Dose Aspirin for the Prevention of Preeclampsia in Pregnant Women: There is sufficient evidence to suggest that low-dose aspirin as a preventative medication does not increase the risk of placental abruption, postpartum hemorrhage, or fetal intracranial hemorrhage.
The 2018 Guidelines for the Diagnosis and Treatment of Hypertension and Preeclampsia in Pregnancy state that there is evidence that low-dose aspirin is safe and has no major adverse effects. Starting low-dose aspirin at week 12 has no significant effect on antepartum or postpartum hemorrhage or infant hemorrhage.
The 2018 ACOG Committee Opinion on the Use of Low-Dose Aspirin During Pregnancy states that daily use of low-dose aspirin (81 mg/day) during pregnancy is currently considered relatively safe, with a low associated risk of serious maternal (or fetal) complications.
As can be seen from the above guidelines, low-dose aspirin is relatively safe for both mother and baby during pregnancy.
This is important to note: low doses are being mentioned!
This means that high doses of aspirin are dangerous for pregnant women.
The aspirin package insert states that, as a precaution, the dosage for long-term treatment should be ≤150 mg/day. During the last trimester of pregnancy, taking high doses of aspirin (>300 mg/day) may lead to prolonged pregnancy, maternal uterine contractions, and fetal cardiotoxicity. Furthermore, it increases the risk of bleeding in both the mother and fetus.
Therefore, remember: low-dose aspirin is used to prevent preeclampsia.
Which pregnant women need to use it preventively?
Not all pregnant women need to use aspirin to prevent preeclampsia.
The guidelines recommend that pregnant women with one or more high-risk factors for preeclampsia and pregnant women with multiple intermediate-risk factors for preeclampsia should receive prophylactic low-dose aspirin treatment.
Aspirin is not recommended for pregnant women with only low-risk factors for prevention.
So how do we know if we have any relevant risk factors? Take a look at the table below~
In other words, the decision to use medication depends on whether there is a corresponding medium- to high-risk condition. Therefore, after becoming pregnant, it is essential to truthfully report your medical history to your doctor so that they can provide better prevention and treatment measures.
So, how should aspirin be used? When should it be started? How long should it be used?
How to use aspirin to prevent preeclampsia?
"2018 ACOG Committee Opinion: Use of Low-Dose Aspirin During Pregnancy" and "2019 ACOG Clinical Management Guidelines for Hypertensive Disorders in Pregnancy by Obstetricians and Gynecologists":
Timing of medication: 12-28 weeks of pregnancy (preferably before 16 weeks).
Dosage: 81 mg of aspirin daily.
Treatment duration: Continue until delivery.
The Chinese guidelines for the diagnosis and treatment of hypertensive disorders of pregnancy (2015) and the aspirin drug package insert:
Timing of medication: Begin taking medication in the early to mid-pregnancy period (12-16 weeks of gestation).
Dosage: Daily low-dose aspirin (50-100mg)
Treatment duration: Can be maintained until 28 weeks of pregnancy.
According to domestic and international guidelines, the timing and dosage of low-dose aspirin for the prevention of preeclampsia are basically consistent, but there is some controversy regarding the course of treatment.
According to the drug instructions in my country, all drugs containing aspirin are contraindicated in women during the last three months of pregnancy, except for very limited use in cardiovascular and obstetric applications under proper clinical expert advice and close monitoring.
Therefore, from a safety perspective, aspirin can be used until the 28th week of pregnancy. Whether it needs to continue until delivery depends on your doctor's decision based on your individual circumstances.
Attention! These products are not suitable for pregnant women!
Although there are few contraindications to the use of aspirin during pregnancy, caution is still necessary. If you have any of the conditions listed below, be sure to inform your doctor truthfully.
What precautions should be taken when using low-dose aspirin during pregnancy?
1. Do not take extra aspirin as a pain reliever.
2. The most common side effects of taking aspirin are gastrointestinal adverse reactions such as indigestion and mild stomach pain. If the symptoms are unbearable, seek medical attention promptly.
3. Try to take your medication at the same time every day.
4. Avoid using other NSAIDs, such as ibuprofen, while taking this medication.
5. Aspirin should not be used during the first three months of pregnancy, as it may cause birth defects.
In summary, low-dose aspirin is currently mainly used during pregnancy to prevent preeclampsia. However, it should be noted that not all pregnant women need to take aspirin for prevention; it is only necessary when relevant risk factors are present.
If you have a history of gastrointestinal bleeding or aspirin allergy before taking this medication, be sure to inform your doctor. When taking the medication, strictly follow the doctor's instructions and do not arbitrarily increase the dosage.
If you experience stomach pain or other intolerable symptoms after taking the medication, please seek medical attention promptly.
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