Some medical centers are taking drastic action to save mothers and babies after studies showed that many doctors are not following guidelines to prevent preeclampsia, a potentially fatal pregnancy complication.
These hospitals now recommend that all their pregnant patients take low-dose aspirin, as studies have shown that the drug is safe and can help prevent preeclampsia, which can lead to high blood pressure and other risks during pregnancy.
The March of Dimes, a nonprofit dedicated to maternal and child health research and advocacy, endorsed this approach last week, saying it may be “medically reasonable” for them to offer the drug to pregnant patients.
This move could pave the way for more doctors to recommend low-dose aspirin to all their patients, as they do with prenatal vitamins.
Preeclampsia, a leading cause of death among mothers and babies, affects 1 in 25 pregnancies in the United States. Black mothers and women with high blood pressure or diabetes, or who are 35 years or older, are at higher risk.
Rates of the disease have increased 25% over the past two decades, according to the Preeclampsia Foundation.
In clinical trials, low-dose aspirin was shown to reduce your risk by 15 percent, reduce the risk of preterm birth by 20 percent, and perinatal mortality (death of the fetus in late pregnancy or the baby in the first week of life) by 20 percent, according to the March of Dimes report.
More than a decade ago, the U.S. Preventive Services Task Force recommended that pregnant women at highest risk of preeclampsia take low-dose aspirin, ideally between weeks 12 and 16 of pregnancy until delivery, as a measure to prevent the complication.
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The American College of Obstetricians and Gynecologists has published similar guidance, but studies indicate that many doctors still do not follow it.
If the majority of pregnant patients in a clinic are at increased risk for preeclampsia, it is reasonable to recommend that they all take low-dose aspirin, said the March of Dimes, whose report, done in collaboration with the California Maternal Quality Care Collaborative, was applauded by some obstetricians, saying it could reduce preeclampsia rates.
“The opinion of such respected, science-backed organizations could really be decisive,” said Dr. Adam Lewkowitz, a preeclampsia expert and assistant professor of obstetrics and gynecology at the Warren Alpert Medical School of Brown University.
“No one mentioned” aspirin
About five weeks before her due date, Angela Jones began speaking incoherently and her vision became blurry. On the way to the hospital, she suffered seizures and does not remember giving birth to her baby by emergency cesarean section.
If her doctors had followed the guidelines of the American College of Obstetricians and Gynecologists, they would have recognized that because Jones was at increased risk for preeclampsia, she should have taken low-dose aspirin during pregnancy.
“No one ever told me about low-dose aspirin,” said Jones, who lives in Downey, California, and shared her story with the California Maternal Quality Care Collaborative. “I didn’t know you could have seizures, have a stroke, or even die from preeclampsia.”
The groups offer a screening tool for doctors to determine which patients should take the drug, and Jones met several criteria: She is black, obese and her first baby in more than 10 years.
A complicated formula
Many obstetricians say women like Jones are overlooked because doctor appointments, which often last only 15 minutes, are too crowded to include a complex assessment of the patient’s risk factors.
A 2022 study from Duke University School of Medicine looked at babies born in the United States in 2019 and found that 85.7% of mothers were candidates for taking low-dose aspirin during pregnancy, but according to the Society for Maternal-Fetal Medicine, less than half of those who should be taking it are doing so.
According to the March of Dimes, aspirin can prevent preeclampsia by improving blood flow to the uterus. Although some studies have shown an increased risk of bleeding for the mother, the organization said a review of 21 randomized controlled trials did not reveal such a risk and said there is no evidence that it is harmful to the mother or her baby.
Because the formula for determining which women should take it can be complicated and time-consuming, more and more hospitals have begun recommending it to all their pregnant patients.
The current guidelines are very strict, according to Dr. David Hackney, chief of the division of maternal-fetal medicine at University Hospitals Cleveland Medical Center. “Everything looks perfect on paper, but then there’s how things work in the real world,” Hackney said.
That’s why the University Hospitals recommended a few months ago the administration of low doses of aspirin to all pregnant women, he said.
The Cleveland Clinic has taken the same step, according to Dr. Adina Kern-Goldberger, an assistant professor at the Cleveland Clinic Lerner School of Medicine.
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Parkland Health in Dallas, one of the busiest maternity hospitals in the United States, began implementing the practice three years ago, said Dr. Elaine Duryea, chief of obstetrics at Parkland and associate professor of obstetrics and gynecology at the University of Texas Southwestern Medical Center. He said his team is tracking preeclampsia rates to see if the policy has worked.
In all of these clinics, patients can choose not to take the medication, although the majority follow its instructions, according to the obstetricians.
Other medical centers have been less enthusiastic.
Northwell Health, New York’s largest health care system, does not recommend aspirin for all pregnant patients, according to Dr. Matthew Blitz, director of clinical research for Northwell Health’s division of maternal-fetal medicine.
“The idea is to do no harm, so giving it to everyone, including those who don’t need it, is still a big concern,” Blitz said.
However, she noted that the screening tool is “time-consuming” and Northwell may decide to recommend low-dose aspirin to all pregnant women.
Jones, the California mother, said she hopes the new report will make a difference.
Last year she became pregnant again, and although the guidelines indicate that she should have received aspirin (one of the criteria is having a history of preeclampsia), she said her doctors did not suggest it until the sixth month, many weeks later than recommended.
She developed preeclampsia again, with dangerously high blood pressure and blurred vision.
“Doctors should inform people about this,” he claimed. “It makes me angry, what the hell is going on in this system?”
