Preeclampsia: Is there an advantage in starting aspirin before the 11th week of pregnancy?

Preeclampsia affects between 2% and 8% of pregnant women, and it carries significant risks of perinatal morbidity and mortality. Indeed, more than 60,000 maternal deaths are associated with preeclampsia each year. Since the late 2000s, it has been confirmed that taking aspirin between the 11th and 16th weeks of pregnancy can help prevent preeclampsia, as well as its complications in women considered to be at risk. “Unfortunately, many doctors have thought that if taking the drug before 16 weeks is better to prevent preeclampsia, it is probably better before 12 weeks as well. It has become common practice to prescribe aspirin very early in pregnancy, without any valid study that has demonstrated its effectiveness and above all its safety,” explains Dr. Emmanuel Bujold, gynecologist-obstetrician and researcher at the Center de recherche du CHU de Québec at Laval University. Read: Diet alone can reduce CVD risk by 10% over a decade—more in women and Black adults He gives the example of Brazil, where the official recommendation is to offer aspirin to all pregnant women from the start of pregnancy to reduce the risk of preeclampsia, a common condition in the country with a rate of 8%. With a research team made up of professionals from various backgrounds, such as pharmacy, biochemistry and fetal medicine, Dr. Bujold set out to determine whether taking the drug before the 11th week of pregnancy could have a positive impact on condition. Prescribed for specific reasons To do this, the team conducted a targeted survey of clinicians specializing in maternal-fetal medicine and fertility from eight different centres in Canada and the U.S., with the aim of knowing if the initiation of aspirin before the 11th week of pregnancy was common practice. Read: Lighter ventricular assist device with longer battery life a game-changer for pediatric heart transplant candidates All 12 clinicians interviewed indicated that it was not common practice to prescribe aspirin before the 11th week of pregnancy for the prevention of preeclampsia. They said, however, that it was relatively common for the drug to be used during the periconceptional period in women undergoing fertility monitoring or those with a history of recurrent miscarriages. The researchers also analyzed a Canadian database that included information on the use of medication by pregnant women before the first ultrasound, usually between the 11th and 13th week of pregnancy. Nearly 11% of pregnant women who had already had at least one pregnancy took aspirin before the 11th week of gestation, despite little evidence of the benefits of the practice. “The results didn’t really surprise me. When a mother finds herself in front of the doctor for repeated miscarriages and therefore repeated disappointments, it is normal for the doctor to want to help,” explains Dr. Bujold. A call for more caution Next, the researchers reviewed studies of aspirin use before the 11th week of pregnancy. "Our conclusion is that there is a great lack of scientific evidence to recommend taking aspirin very early in pregnancy," says the doctor. He calls on clinicians to be cautious and stick to the evidence until there are more studies on the use of aspirin before the 11th week of pregnancy since its efficacy and safety have not been demonstrated. “Perhaps over time we will realize that taking aspirin at the very beginning of pregnancy is effective and safe,” says Dr. Bujold. “But for the moment, this is not yet the case. Doctors should continue to identify women at risk of preeclampsia and stick to prescribing aspirin from the 11th or 12th week of pregnancy.” He also invites clinicians and patients to participate in clinical studies on the subject. Study results were published in the journal Pregnancy Hypertension. This article has been translated from its original French and originally appeared on our sister site Profession Santé. Read: DRUG QUIZ: Chronic heart failure

Preeclampsia: Is there an advantage in starting aspirin before the 11th week of pregnancy?

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