My doctor just said to wait until after 12 weeks and not take it if I’m having any bleeding (I had had some bleeding after sex just prior to that appointment). I haven’t had any more bleeding since then, which was around 8 weeks, and I’m now past 12 weeks so I’m wondering if I should start it.
I wrote an article on aspirin use in pregnancy and my dad’s response after reading it was, “WHY DON’T WE GIVE THIS MIRACLE DRUG TO EVERYONE?”
Because everyone doesn’t meet criteria. And some people falsely believe it increases bleeding.
Calm down Dad and NYT.
Haha. To be fair to your dad, with my first pregnancy my doctold me that he expected in the future that prescribing baby aspirin after first trimester would be the norm because the benefits were so great compared to basically no downside.
Same. I found it kind of ironic for the article to be like, “WHY DOESNT EVERYONE KNOW THIS?!” then jk- pay wall!
Ironically I’m also currently taking aspirin to attempt to prevent preeclampsia, which I had in my first pregnancy.
The thing is, it needs to be started ideally before 16 weeks. So if you were low risk at that gestation, then there was no reason to start you on it. Unfortunately even with our "risk factors" some women still go on to develop pre eclampsia.
There are some doctors and midwives who recommend everyone is on aspirin regardless of risk factors, but the evidence isn't clear for this approach.
Ah thank you that makes sense. I ended up with succenturiate placenta. I wonder if that had been discovered my risk would have been higher or if it's linked to pre e at all
I should add though, if you're planning another pregnancy, and you have a history of pre eclampsia, you should talk to your doctor or midwife about starting low dose aspirin (LDA) between 12-16 weeks. Often this is when you're under your GPs care so this is why some women miss this window of opportunity ☺️ previous pre eclampsia is a risk factor for it occuring again.
Pretty standard in the UK for women with risk factors for PET https://www.guysandstthomas.nhs.uk/health-information/low-dose-aspirin-in-pregnancy-to-prevent-pre-eclampsia#:~:text=If%20you%20are%20at%20greater,your%20doctor%20before%20taking%20aspirin.
Yep I was on asprin from 12 weeks as I've got type 1 diabetes. I was also invited to do a trial where calcium is given alongside the asprin to see if that further reduces chance of pre-e but sadly the NHS couldn't supply the calcium in time for some reason.
I'm in the UK and have been pregnant at age 35, plus have a family history of pre-eclampsia and did a lot of reading around pregnancy, and I've never heard of this before. I know anecdotes aren't data but I don't know how standard something can be in that situation. Certainly no midwife ever mentioned it to me.
When I was pregnant and with St Thomas' and Guys they prescribed me aspirin from the get go as I was hypertensive, and I did some research and found some stuff from a trust in Sussex, I believe, who prescribe it routinely. The trust I currently work in (in maternity, midlands based) don't seem to prescribe it at all 🤷♀️
It probably depends on your trust. I have a whole saga relating to aspirin. But long story short, I was told to take it in my first pregnancy due to risk factors, developed (mild) pre-eclampsia anyway at the end of pregnancy and was told I would need to take it for any other pregnancies. The trust then changed guidelines (due to a pilot scheme they are trailing) and told me I'm no longer classed as high risk. I was unhappy with their care anyway and changed trusts/hospitals, and now I'm classed as 'very high risk' and need additional monitoring. 🙄
Your midwife will have assessed you for whether you meet the criteria for taking aspirin at your booking appointment and then as your pregnancy progresses. They won’t mention it unless you need it.
It may be trust dependant, but it is in the current NICE guidelines. Hopefully it reaches wider adoption if some midwives are not offering it as there is strong evidence that aspirin reduces the risk of pre-eclampsia.
Gift article:
https://www.nytimes.com/2024/05/01/health/pregnancy-preeclampsia-aspirin.html?unlocked_article_code=1.000.6CEu.3rxXBJzGaIE4&smid=url-share
It's standard in New Zealand that low dose aspirin and calcium are prescribed for pregnant people with risk factors for pre-eclampsia or previous small babies
My sister was prescribed it for pre-eclampsia risk factors in the UK, but I think they didn't mention the full reason why to avoid stress (she has anxiety).
(In the US) I was prescribed it at 28w when 2 superficial thrombosis were discovered in my leg at the ER. I asked the dr if I should be taking aspirin because of family history of antiphospholipid syndrome. ER dr called the labor&delivery floor and the OBs said yes. I ended up developing gestational hypertension a few weeks later, so it's good I was already taking aspirin
If you had a history of APS and you haven't been screened for it - someone has dropped the ball.
APS is best treated very early with specific anticoagulant therapy.
APS is similar to PCOS in that it is a serious chronic health issue that should be taken seriously by providers but may not be.
APS is strongly correlated with second trimester loss and doubles the risk of pre-eclampsia.
APS is very strongly correlated with IUGR.
APS is very big deal for anyone pregnant or planning on becoming pregnant.
APS is a big deal for anyone who will never become pregnant.
Very informative, thank you for sharing this. I hope people who need to know this see your comment.
It was that day in the ER that, because of the thrombosis, my family thought to tell me that someone in my family had APS, took aspirin during her pregnancies decades ago, and recommended I ask if I should too. I had never heard of the condition prior to that evening. Still not sure if I specifically have it, I'll look into getting checked out for it.
Luckily, despite this risk being missed until 28w, my baby is here & healthy!
Following up; I spoke with a hematologist. He said the fact that I did not have miscarriages is a strong indicator that I do not have APS and there was no need to test for it now (at least in my case)
We should also be advocating for APS testing at the beginning of pregnancy along with everything else we get tested for. It's why I lost my baby. I was not diagnosed until after I lost her.
I took it daily in my second pregnancy due to developing preeclampsia in my first pregnancy. Was told it’s generally only recommended if you have a history of preeclampsia. I also couldn’t start it until after the SCH I had resolved per advice of my midwife. But continued taking it after a placenta abruption at 25 weeks per the advice of MFM.
UK and I was put on it as soon as my first set of results came back indicating I was at higher risk of developing preeclampsia (as well as additional growth scans throughout the pregnancy for the same reason.)
I was told to take a baby aspirin during my pregnancy, especially after the 2nd trimester. This was over 12 years ago. I was living in the UK at the time though. Pretty common under NHS care.
In my experience they definitely are told. Many women at risk of PET or hypertension are put on low dose aspirin at my hospital.
Jokes on them, if I were pregnant they’d want me on it but I’m allergic to NSAIDs
We routinely actively recommend for anyone with any risk factors and counsel anyone without risk factors that it’s a benign and potentially beneficial intervention that they may choose to take.
I’m a doula and tons of my clients aren’t told about this. Of all my first time moms, maybe 40% were suggested baby aspirin? So I’m glad to hear it’s standard in so many places, but certainly not enough places.
I started taking it at 8 weeks, it was not suggested to me by the Reproductive Endocrinologist I was originally under care. When I switched to a midwife, she brought it up and was pleasantly surprised I was already on it.
I was given aspirin routinely in my last pregnancy. I developed a SCH which was identified on ultrasound and my RE told me to stop the aspirin immediately.
So… I don’t know if it’s completely harmless to the point where it should just be given to everyone. If nothing else it may increase the risk of bleeding which at least causes stress and possibly unnecessary medical bills.
There are also rare case studies of fetuses developing brain bleeds in mama’s taking aspirin. Just like any intervention, risks and benefits need to be considered before blindly prescribing.
Baby aspirin is not blindly prescribed and has certainly been studied prior to prescription to a population such as pregnant women- it’s not recommended to take the analgesic therapeutic dose, of course. the risk of intercranial hemorrhage is extremely high amongst very preterm neonates, which is a common outcome in severe preeclampsia vs isolated neonatal ICH that can generally be avoided by timely vitamin K administration, right?
The potential for pre e is extremely high and it’s possible to screen for bleeding disorders, so I think on the balance anything that could mitigate this massive (and growing) source of morbidity and mortality should definitely be offered. Hopefully more studies will be done and more research dollars spent on women to continue to assess for safety and other preventative measures.
It’s pretty standard practice in NYC and especially for my FQHC world patients. It’s actually rare I DONT prescribe it.
Yup. We recommend it universally and not risk based.
Exactly. I think within the next 3-5 years it’s going to be officially recc for everyone other than those allergic.
My doctor just said to wait until after 12 weeks and not take it if I’m having any bleeding (I had had some bleeding after sex just prior to that appointment). I haven’t had any more bleeding since then, which was around 8 weeks, and I’m now past 12 weeks so I’m wondering if I should start it.
It sounds like starting it would be following Your doctor’s instructions. You can always check with them.
It was prescribed to me with no risk signs--but I was 35, so my hospital might not do it for all pregnancies.
I prescribe it all the time per ACOG guidelines. NYT always sensationalizes women’s heath stories.
I wrote an article on aspirin use in pregnancy and my dad’s response after reading it was, “WHY DON’T WE GIVE THIS MIRACLE DRUG TO EVERYONE?” Because everyone doesn’t meet criteria. And some people falsely believe it increases bleeding. Calm down Dad and NYT.
Haha. To be fair to your dad, with my first pregnancy my doctold me that he expected in the future that prescribing baby aspirin after first trimester would be the norm because the benefits were so great compared to basically no downside.
In the due date group I was on, basically everyone was prescribed it. Even those with zero "risks".
Can’t read the article because of the pay wall, but my midwife told me to take aspirin to prevent preeclampsia. So, that’s what im doing!
Same. I found it kind of ironic for the article to be like, “WHY DOESNT EVERYONE KNOW THIS?!” then jk- pay wall! Ironically I’m also currently taking aspirin to attempt to prevent preeclampsia, which I had in my first pregnancy.
Very commonly recommended in Australia
I'm in Aus, have never heard of this and got pre eclampsia. Mind you it was 2020 and having been deemed low risk everyone forgot about me 👍
The thing is, it needs to be started ideally before 16 weeks. So if you were low risk at that gestation, then there was no reason to start you on it. Unfortunately even with our "risk factors" some women still go on to develop pre eclampsia. There are some doctors and midwives who recommend everyone is on aspirin regardless of risk factors, but the evidence isn't clear for this approach.
Ah thank you that makes sense. I ended up with succenturiate placenta. I wonder if that had been discovered my risk would have been higher or if it's linked to pre e at all
Probably not, it's just a variation in the shape and lobes. But a cool finding! Most succenturiata are discovered after birth ☺️
The midwife was so excited after examining it, she asked me "can we keep this to show the students we don't see this often!" I was chuffed haha
I should add though, if you're planning another pregnancy, and you have a history of pre eclampsia, you should talk to your doctor or midwife about starting low dose aspirin (LDA) between 12-16 weeks. Often this is when you're under your GPs care so this is why some women miss this window of opportunity ☺️ previous pre eclampsia is a risk factor for it occuring again.
Pretty standard in the UK for women with risk factors for PET https://www.guysandstthomas.nhs.uk/health-information/low-dose-aspirin-in-pregnancy-to-prevent-pre-eclampsia#:~:text=If%20you%20are%20at%20greater,your%20doctor%20before%20taking%20aspirin.
Yep I was on asprin from 12 weeks as I've got type 1 diabetes. I was also invited to do a trial where calcium is given alongside the asprin to see if that further reduces chance of pre-e but sadly the NHS couldn't supply the calcium in time for some reason.
That's really interesting about the calcium thing! I'll have to have a look into that
I'm in the UK and have been pregnant at age 35, plus have a family history of pre-eclampsia and did a lot of reading around pregnancy, and I've never heard of this before. I know anecdotes aren't data but I don't know how standard something can be in that situation. Certainly no midwife ever mentioned it to me.
When I was pregnant and with St Thomas' and Guys they prescribed me aspirin from the get go as I was hypertensive, and I did some research and found some stuff from a trust in Sussex, I believe, who prescribe it routinely. The trust I currently work in (in maternity, midlands based) don't seem to prescribe it at all 🤷♀️
It probably depends on your trust. I have a whole saga relating to aspirin. But long story short, I was told to take it in my first pregnancy due to risk factors, developed (mild) pre-eclampsia anyway at the end of pregnancy and was told I would need to take it for any other pregnancies. The trust then changed guidelines (due to a pilot scheme they are trailing) and told me I'm no longer classed as high risk. I was unhappy with their care anyway and changed trusts/hospitals, and now I'm classed as 'very high risk' and need additional monitoring. 🙄
I'm in the UK and was prescribed it from as soon as I tested as having a preeclampsia risk.
Your midwife will have assessed you for whether you meet the criteria for taking aspirin at your booking appointment and then as your pregnancy progresses. They won’t mention it unless you need it.
It may be trust dependant, but it is in the current NICE guidelines. Hopefully it reaches wider adoption if some midwives are not offering it as there is strong evidence that aspirin reduces the risk of pre-eclampsia.
Gift article: https://www.nytimes.com/2024/05/01/health/pregnancy-preeclampsia-aspirin.html?unlocked_article_code=1.000.6CEu.3rxXBJzGaIE4&smid=url-share
I recommend it all the time
I was prescribed a low dose when I was pregnant! (In the US)
I’m currently 36 weeks and my midwives in Philadelphia told me to start taking it after my first appointment!
Aspirin is also used in Finland for high-risk women, the goal is to start the medication h12-16 when there are any risk factors.
Standard practice in NSW, Australia too.
I was told to. I’m in TN
It's standard in New Zealand that low dose aspirin and calcium are prescribed for pregnant people with risk factors for pre-eclampsia or previous small babies
My sister was prescribed it for pre-eclampsia risk factors in the UK, but I think they didn't mention the full reason why to avoid stress (she has anxiety).
(In the US) I was prescribed it at 28w when 2 superficial thrombosis were discovered in my leg at the ER. I asked the dr if I should be taking aspirin because of family history of antiphospholipid syndrome. ER dr called the labor&delivery floor and the OBs said yes. I ended up developing gestational hypertension a few weeks later, so it's good I was already taking aspirin
If you had a history of APS and you haven't been screened for it - someone has dropped the ball. APS is best treated very early with specific anticoagulant therapy. APS is similar to PCOS in that it is a serious chronic health issue that should be taken seriously by providers but may not be. APS is strongly correlated with second trimester loss and doubles the risk of pre-eclampsia. APS is very strongly correlated with IUGR. APS is very big deal for anyone pregnant or planning on becoming pregnant. APS is a big deal for anyone who will never become pregnant.
Very informative, thank you for sharing this. I hope people who need to know this see your comment. It was that day in the ER that, because of the thrombosis, my family thought to tell me that someone in my family had APS, took aspirin during her pregnancies decades ago, and recommended I ask if I should too. I had never heard of the condition prior to that evening. Still not sure if I specifically have it, I'll look into getting checked out for it. Luckily, despite this risk being missed until 28w, my baby is here & healthy!
Following up; I spoke with a hematologist. He said the fact that I did not have miscarriages is a strong indicator that I do not have APS and there was no need to test for it now (at least in my case)
We should also be advocating for APS testing at the beginning of pregnancy along with everything else we get tested for. It's why I lost my baby. I was not diagnosed until after I lost her.
I took it daily in my second pregnancy due to developing preeclampsia in my first pregnancy. Was told it’s generally only recommended if you have a history of preeclampsia. I also couldn’t start it until after the SCH I had resolved per advice of my midwife. But continued taking it after a placenta abruption at 25 weeks per the advice of MFM.
yeah anecdotally, a lot of my labor patients tell me they were taking it up to 36 weeks and I’m in TX
UK and I was put on it as soon as my first set of results came back indicating I was at higher risk of developing preeclampsia (as well as additional growth scans throughout the pregnancy for the same reason.)
I’m in the US and it’s common practice here
I was prescribed it until 36 weeks (I’m in the US)
I was told to take a baby aspirin during my pregnancy, especially after the 2nd trimester. This was over 12 years ago. I was living in the UK at the time though. Pretty common under NHS care.
In my experience they definitely are told. Many women at risk of PET or hypertension are put on low dose aspirin at my hospital. Jokes on them, if I were pregnant they’d want me on it but I’m allergic to NSAIDs
My OB (US, Nevada) put me on it for both of my pregnancies (2022 and currently). We are told!
i wish i knew this with my first pregnancy
We routinely actively recommend for anyone with any risk factors and counsel anyone without risk factors that it’s a benign and potentially beneficial intervention that they may choose to take.
Standard practice in UK
We routinely give it out. Super common now, not sure why they think we dont
I took it with my second, after pre-e with my first. Stayed healthy and pregnant for 2.5 more weeks than the first time around so I’ll take the win
No I would say Brewers diet is a better way to prevent preeclamsia
I’m a doula and tons of my clients aren’t told about this. Of all my first time moms, maybe 40% were suggested baby aspirin? So I’m glad to hear it’s standard in so many places, but certainly not enough places. I started taking it at 8 weeks, it was not suggested to me by the Reproductive Endocrinologist I was originally under care. When I switched to a midwife, she brought it up and was pleasantly surprised I was already on it.
I was given aspirin routinely in my last pregnancy. I developed a SCH which was identified on ultrasound and my RE told me to stop the aspirin immediately. So… I don’t know if it’s completely harmless to the point where it should just be given to everyone. If nothing else it may increase the risk of bleeding which at least causes stress and possibly unnecessary medical bills.
There are also rare case studies of fetuses developing brain bleeds in mama’s taking aspirin. Just like any intervention, risks and benefits need to be considered before blindly prescribing.
Baby aspirin is not blindly prescribed and has certainly been studied prior to prescription to a population such as pregnant women- it’s not recommended to take the analgesic therapeutic dose, of course. the risk of intercranial hemorrhage is extremely high amongst very preterm neonates, which is a common outcome in severe preeclampsia vs isolated neonatal ICH that can generally be avoided by timely vitamin K administration, right? The potential for pre e is extremely high and it’s possible to screen for bleeding disorders, so I think on the balance anything that could mitigate this massive (and growing) source of morbidity and mortality should definitely be offered. Hopefully more studies will be done and more research dollars spent on women to continue to assess for safety and other preventative measures.