While I was growing up, for many years on the TV I would commonly see advertisements for “Bayer Aspirin – The Wonder Drug.” Well, that is now more true than perhaps ever before!
It has long been known that taking aspirin helps reduce the risk of heart attack. Basically, anyone who has ever had a myocardial infarction has not gone home from the hospital without being placed on a regular aspirin for the remainder of their lives. This is because of aspirin’s ability to prevent platelets from sticking together to form blood clots. Because of aspirins ability to thin the blood and its ability to also be anti-inflammatory, it has been used in obstetrics in treating anti-phospholipid antibody syndrome and other connective tissue disorders associated with recurrent miscarriages. It may be used in conjunction with other blood thinners such as Lovenox or heparin.
In brand new recommendations from the United States Preventive Services Task Force (USPSTF) the use of baby aspirin 81 mg has now been recommended for prevention of preeclampsia, preterm birth, and Intrauterine Growth Restriction or IUGR. Previous studies have shown a 9 percent reduction in recurrent miscarriage with the use of baby aspirin. The USPSTF now recommends the use of baby aspirin to reduce the risk of preeclampsia by 24 percent, the risk of preterm birth by 14 percent, and the risk of IUGR by 20 percent. This is a really big deal!
These new recommendations are the result of a meta-analysis of 23 different studies involving low dose aspirin by Jillian Henderson, Ph.d., of Kaiser Permanente Northwest, Portland, Oregon, and associates. These included both randomized controlled and observational studies. Preeclampsia continues to play a major role in maternal morbidity and mortality as well as causing babies to be born prematurely with all of its attendant risks. If the risk of preeclampsia can be cut by 24 percent while at the same time reducing the risk of preterm delivery by 14 percent, this would save hundreds of millions of dollars, and save or improve the lives of millions of mothers and their unborn children!
The USPSTF also concluded that there is “adequate evidence” that the risks of postpartum bleeding, placental abruption, and fetal intra cranial hemorrhage were not increased. This is therefore classified as a category “B” recommendation in that there is “high certainty that the benefit is moderate to substantial.”
This however does NOT mean that every single pregnant woman should now take a baby aspirin throughout her pregnancy. This DOES mean that certain women who are at an increased risk of preeclampsia, preterm birth, or IUGR may indeed benefit from a daily baby aspirin during the course of their pregnancies. Each individual woman should therefore talk to her obstetrical provider to discuss this issue.
In addition to baby aspirin, vaginal progesterone has also been recently recommended for women at risk for preterm delivery with a shortened cervix. This special type of ultrasound needs to be performed vaginally and at a facility with a trained ultrasonographer who is accustomed to performing them on a regular basis. For women with previous preterm birth 17-OH progesterone caproate is used intra-muscularly (250 mg) starting at 16 weeks gestation.
In conclusion, baby aspirin (81 mg) may indeed be the obstetrical “wonder drug.” It may again reduce the risk of preeclampsia by 24 percent in high risk women, reduce the risk of preterm birth by 14 percent, and reduce the likelihood of IUGR by a whopping 20 percent.
Please note that regular aspirin, 325 mg, is NOT recommended, as taking a regular aspirin can cause “premature closure of the ductus arteriosis” or premature closure of vital fetal circulation necessary for fetal life. I highly recommend that you counsel with your obstetrician regarding your own personal risk and make decisions regarding you and your baby together.
For further inquiry contact Dr. Saunders OB/GYN at www.drsaundersobgyn.com or call 801-692-1429.
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