Preventing Preeclampsia: Low-Dose Aspirin Saves Lives

A few days before 11-time Olympic medalist Alyson Felix needed an emergency c-section at 32 weeks, she complained to her family about swollen feet. Relatives around the Thanksgiving meal all commiserated, but no one mentioned the symptom is an early sign of preeclampsia.
As a professional track and field athlete who trained through pregnancy, Felix was shocked to be diagnosed with severe preeclampsia. Today, Felix is championing the established preventative treatment for preeclampsia as part of the March of Dimes’s Low Dose, Big Benefits campaign. The campaign aims to inform more primary care physicians, OB/GYN providers and their patients about the benefits of taking a low dose of aspirin to reduce the onset of preeclampsia.
Michael Paidas, M.D., a leading preeclampsia researcher and department chair of obstetrics, gynecology and reproductive sciences at the University of Miami Health System and the University of Miami Miller School of Medicine, says taking low-dose aspirin during pregnancy is safe.
Dr. Paidas hopes taking aspirin for those at higher risk for preeclampsia will become as common as prenatal vitamins. “I want to get to the point where patients ask their doctors to talk about aspirin. We have to put it front and center into their consciousness,” he says.
What is preeclampsia?
Preeclampsia is a severe pregnancy complication of gestational hypertension that can happen any time after the second trimester and even after giving birth. It usually occurs after 20 weeks of pregnancy in women whose blood pressure had previously been normal.
Left untreated, preeclampsia can lead to serious, even fatal, complications for both the mother and the baby. It’s a leading cause of maternal death, maternal intensive care admissions, cesarean section and infant prematurity.
Preeclampsia’s causes elude the healthcare community, but aspirin has been proven a safe and effective preventative treatment.
A systematic review of studies from the U.S. Preventative Services Task Force says that taking aspirin reduces the risk of preeclampsia by 15%, the risk of premature birth by 20%, and the risk of another complication, intrauterine growth restriction, by 18%.
Moderate exercise throughout pregnancy of at least 140 minutes per week also helps reduce the risk of preeclampsia. Dr. Paidas recommends patients walk 20-30 minutes every day to reduce their risk.
Who is at high risk for preeclampsia?
Preeclampsia is a factor in up to 5-7% of pregnancies in the United States. Rates are higher among some groups, like Black women. The rate of preeclampsia among Black women is 60% higher than white women, according to the CDC.
Preeclampsia is one of the leading causes of maternal mortality nationwide. Hundreds of women die from pregnancy or postpartum every year in the U.S. –– the highest rate of any developed country.
The following makes pregnant women more at risk for preeclampsia:
- History of preeclampsia in previous pregnancies
- Multiple pregnancies (e.g., twins or triplets)
- Chronic hypertension or other cardiovascular conditions
- Chronic kidney disease
- Diabetes
- Obesity
- COVID during pregnancy
- Advanced maternal age (over 35)
- Certain autoimmune conditions
- Conditions that increase the risk of blood clots
Rates of preeclampsia in the U.S. have increased in recent years. Dr. Paidas says this is likely because an increasing number of women are getting pregnant at a later age and rising obesity rates.
Taking aspirin to prevent preeclampsia
Low-dose aspirin (81 mg daily) has been shown to reduce the risk of preeclampsia in women at high risk. It is often started after the first trimester (between 12 and 16 weeks of pregnancy) and continued until delivery. Most low-dose aspirin pills are formulated to be exactly 81 mg each.
Always consult a healthcare provider before starting aspirin during pregnancy.
Despite the data showing low-dose aspirin prevents preeclampsia, a new survey from The Harris Poll on behalf of March of Dimes revealed nearly 1 in 5 families had never heard of preeclampsia. The number rose to over 1 in 4 for Black families.
Increasing awareness of how low-dose aspirin prevents preeclampsia is key to healthier outcomes for women and babies.
More preeclampsia research is needed
While low-dose aspirin can go a long way in preventing preeclampsia and lowering the maternal mortality rate in the U.S., more research is needed on how to diagnose and treat preeclampsia. More research is also needed to determine whether a higher dose of low-dose aspirin (approximately double the 81 mg dose) is better and as safe as the current recommended dose.
A mother with severe preeclampsia is at risk for seizures and even death, so delivery is the standard treatment after disease onset. “The longer that you stay pregnant with the disease, the greater the maternal risk,” says Dr. Paidas.
Finding ways to diagnose preeclampsia early and treating patients will help prolong pregnancy and lead to more positive outcomes for women and babies. “The maternal mortality associated with the disease is somewhat hard to predict,” says Dr. Paidas.
The good news is that low-dose aspirin goes a long way in preeclampsia prevention. The more doctors and patients aware of its benefits and safety, the more we can reduce the rate of preeclampsia in the U.S.
Wendy Margolin is a contributor for UHealth’s news service.
Tags: Dr. Michael Paidas, emergency c-section, maternal health awareness, preeclampsia symptoms