Hello. I am 35 and 12 weeks pregnant with a second baby. Today I had my OB appointment, and the doctor suggested that I should start taking 80mg of baby aspirin till week 34. I don’t currently have any complications, have never had high blood pressure or any related issues. I try to stay active (swimming) and be healthy monitoring my BS levels. I had a healthy first pregnancy when I was 29. I question the necessity of taking aspirin during pregnancy “just in case”. I also read that aspirin (adult doses) is harmful for developing baby. Has anyone had similar experience? Which path did you choose?
I have only encountered the aspirin dilemma as part of TTC. It is supposed to help with implantation and earliest (like first 8 weeks or less) development. Even so, I didn’t take it. The research I read is inconclusive on the effects and I personally prefer not to put in my body anything unnecessary, let alone when pregnant.
I would however recommend you discuss with your doctors taking a HIGH DOSE of folate (or folic acid, but the folate formulation seems to work even better), which is consistently recommended for T1D women. You probably already have at least 800mcg in your prenatal, but in Europe (here is the UK official one as one example: https://www.nhs.uk/Conditions/pregnancy-and-baby/pages/diabetes-pregnant.aspx) the recommendations for T1D women are 5 mg daily! I took that during the first 12 weeks and then 3mg throughout the rest of the pregnancy.
Thanks for sharing your experience! I should find the research related to baby aspirin/preeclamsia/T1D/age over 35.
Yes, I am aware of the benefits of taking folic acid while TTC and in early pregnancy. I took 1200mcg before and throughout my first pregnancy. Right now I am taking 800mcg as a part of pre natal vit + 2 mg. I was taking 5 mg when TTC. Thanks again!
Here are some of the things I remember reading on low-dose aspirin:
The official default recommendation for T1D women (and 35+ too) can be found here: https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/low-dose-aspirin-use-for-the-prevention-of-morbidity-and-mortality-from-preeclampsia-preventive-medication and summarized in lay language here: https://www.webmd.com/baby/news/20140407/aspirin-advised-for-women-at-high-risk-for-pregnancy-complication#1 and here: https://www.webmd.com/baby/news/20140908/give-aspirin-to-all-pregnant-women-at-risk-of-preeclampsia-us-experts#2. If you have no history of high BP or pre-eclampsia during an earlier pregnancy, and all your results remain good during the frequent pregnancy checks you’re having (that was my situation), I don’t see the need, as I said. Obviously if things change, then it could be helpful.
https://www.nih.gov/news-events/news-releases/aspirin-does-not-prevent-pregnancy-loss-nih-study-finds (this was for aspirin while TTC and early on)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5069612/ (more for background; explains what the supposed mechanisms of beneficial effects might be)
This is a book so you need to search within it for what aspects might interest you. It covers a wide variety of “high-risk” scenarios for pre-eclampsia together, not just diabetes, and here is what I think is the briefest statement of their conclusion on the basis of meta-analysis of a bunch of studies:
Based on pooled results, low-dose aspirin administered after the first trimester of pregnancy to women at elevated risk of preeclampsia modestly reduced the risk of preeclampsia and associated perinatal health outcomes (i.e., IUGR, preterm birth). Available evidence suggests that this reduction is at least a 10 percent risk reduction in preeclampsia (and perhaps a 24% reduction) (Figure 2). A meta-analysis revealed a 14 and 20 percent reduced risk of preterm birth and IUGR, respectively (Figures 3 and 4). The actual effect may be more modest, however, given the possible bias due to small-study effects. Consistent with findings of reduced preterm birth and IUGR, birth weight averaged 130 g more in infants whose mothers took low-dose aspirin. We did not find evidence of serious harms from aspirin use (i.e., no effect on perinatal mortality), although power was limited for such a rare event; individual trials were inconsistent, with nonstatistically significant findings in the direction of either modest benefit or harm. Pooling suggested a trend toward reduced (rather than increased) risk of perinatal mortality (RR, 0.92 [95% CI, 0.76 to 1.11]), with a tendency toward further reduced risk when pooling was limited to women at elevated risk for preeclampsia (Figure 5). Similarly, although more sparsely reported, available evidence suggested no effect of intracranial fetal bleeding with low-dose aspirin (RR, 0.84 [95% CI, 0.61 to 1.16]) (Figure 6). Although there was no overall effect of low-dose aspirin on other possible maternal harms (i.e., postpartum hemorrhage, Cesarean delivery), we could not rule out the possibility that it was associated with an increased risk of placental abruption because of sparse reporting, power limitations, and heterogeneity of populations in the studies reporting this outcome (RR, 1.17 [95% CI, 0.93 to 1.48]). Pooling only among trials enrolling higher-risk pregnant women (the target for aspirin intervention) somewhat attenuated the potential harm but reduced the precision, and results remained heterogeneous (RR, 1.12 [95% CI, 0.86 to 1.46]; I2=50.1%; p=0.14). Although not statistically significant, based on these estimates, the number needed to treat to harm (NNH) one person was 417 in women at high preeclampsia risk, assuming a baseline risk of 2.0 percent of women having an abruption (which was consistent with the Maternal-Fetal Medicine Unit [MFMU] trial). If a baseline risk of 1.5 percent is assumed (consistent with CLASP), then the NNH increases to 556 in women at risk of preeclampsia. The NNH across all trials, including women at low or average risk, was 297 assuming 2 percent abruption incidence, or 392 with 1.5 percent abruption incidence.72,76 Two observational studies on aspirin use during pregnancy had null findings for the potentially harmful outcomes considered, miscarriage and cryptorchidism.77,78
We did not find direct evidence that low-dose aspirin use improved any maternal health outcomes related to preeclampsia in women at elevated risk, although power was limited for these relatively rare events (Table 2). We did find evidence of improved perinatal health, however, with 20 percent lower rates of IUGR (95% CI, 0.65 to 0.99; k=13; n=12,504; I2=36.9%) and 14 percent lower rates of preterm birth (95% CI, 0.76 to 0.98; k=10; n=11,779; I2=33.2%) in women randomized to low-dose aspirin, and no effect or a possible slight reduction in perinatal mortality (Figures 3 and 4, Table 3). The presence of small-study effects in the body of evidence for these outcomes, however, might mean that the magnitude of benefit for all fetal outcomes is lower than the findings from pooled analyses indicated.
I like this book a lot and the approach of one of the authors, Lois Jovanovic, to pregnant women with T1D in general: https://books.google.com/books?id=I03DBwAAQBAJ&dq (you can search within or browse through the ToC). They discuss aspirin use on pp.333-335 and do not include taking it in their recommendations.
Another (and a more recent edition) comprehensive book, where the clinical decision these doctors take is different (i.e., they do prescribe it for their patients): https://books.google.com/books?id=Aeg2DwAAQBAJ&dq
And what should have been the ultimate decisive recommendation, considering the authoritative source:
https://www.acog.org/About-ACOG/News-Room/Practice-Advisories/Practice-Advisory-Low-Dose-Aspirin-and-Prevention-of-Preeclampsia-Updated-Recommendations (I love the recommendation phrase used here: “consider the use”. Very telling of how conflicted the advice ultimately is.)
My obe recommended it. My GP was against it. conflicted, for sure.
Dessito, you are a well of resources! Thank you!
JustLookin, Oh, that is conflicting for sure. What did you end up doing then?
I ended up taking it, but lost the pregnancy anyway at about 10 weeks, so I guess it was a moot point. I am not taking it now.
I have not decided if I will take it again if i get pregnant again. I did not take it during my last 2 pregnancies (at 38 yo and 42 yo).
From the literature, it probably is not dangerous, and it may be helpful. So nothing concrete.
My perinatologist recommended I start on baby aspirin at my 14 week ultrasound due ONLY to the diabetes. I have always had blood pressures in the lower ranges, eat healthy (vegan mostly) and am active. This is my first pregnancy so there are a lot of unknowns, but after doing the research I decided against taking it. My OB has never brought it up herself and I am fine with that!
I found two journal articles that ultimately made up my mind. The first found that the aspirin really only had an effect on women who had borderline high blood pressure before conceiving/early on in pregnancy. The second was a larger European study that found an increase in placental abrasion in mother’s who took 41mg of aspirin a day (that was half the dose my doctor recommended). Unfortunately, I am no where near as organized as Dessito or I would still have the links to these!
I have been keeping an extra eye on my blood pressure and trying to focus on healthy foods that combat it. So far so good at 23 weeks.
I am sorry to hear about your loss and hope everything will be ok if you decide to have another little one.
Thank you for sharing the information. It’s valuable for me to learn about other people’s experience.
As far as I know Aspirin has no effects on blood pressure (only on blood clotting, hence it is recommended if someone has a higher blood clotting probability to prevent early miscarriages) I dont see a way on how this drug could lower blood pressure.
or did i miss something @Dessito ?
Thank you! This is very helpful! I think, the aspirin approach is somewhat new, since none of my doctors mentioned it during my first pregnancy 5 years ago. I found a lot of information regarding aspirin use in high risk women, but unfortunately all of the articles/studies have similar results and advise. I tried to find the European study you mentioned, but I wasn’t successful If you do come across it by any chance, please share : )
As far as I understand, aspirin as a blood thinner prevents blood clots and trombosis, and if there is no obstruction in the blood flow, it helps reduce the chances of high pressure. However, elevated blood pressure can be caused by other things… Just my two cents : )
fair point. does it help anyone or just the ones who are prone to blood clotting? do you know?
They appear to have a list of “high risk” women, who they suggest to take aspirin. This list includes women with diabetes (types 1,2), women who are pregnant with twins, and a few more. So if you have diabetes, it’s automatically considered high risk.
My endo wants me to start baby aspirin now (I’m 8 weeks). I believe for the risk of preeclampsia. I’ve never had high blood pressure and am active, so I don’t think I will take it.
Just let your doctor know about this. While it’s your decision to take or not take the meds, it is your doctor’s right to know what you take (and don’t take) so he has all the facts to ensure the best treatment for you
Best of luck with your pregnancy!!
That’s what I decided too. There are no studies in the babies whose mom’s were taking aspirin during pregnancy, which is a concern for me. Good luck to you too!
Your doctor should tell you why he/she is prescribing something. And of course always do your research for medications you put into your body. I thought for a while that I needed to be on low dose aspirin while ttc, and I recently had a my new obgyn confirm it. I have t1d, Hashimoto’s, and MTHFR so the aspirin is mostly for the MTHFR. I rarely take otc pain meds so this was not something that I was excited about putting into my body, but if my doctor thinks I need it to get and keep a healthy pregnancy, I will take it.
My high risk OB put me on it at 12 weeks to prevent preeclampsia and to prevent a breakdown of the placenta. He told me it’s the single most important thing I can do for my pregnancy.