Low-dose aspirin (LDA) prophylaxis is a safe and effective method to help prevent or delay preeclampsia in at-risk patients.

Published: December 15, 2022

Low-dose aspirin (LDA) prophylaxis is a safe and effective method to help prevent or delay preeclampsia in at-risk patients. The cyclooxygenase inhibitor carries anti-inflammatory and anti-platelet properties that can support a patient’s health during pregnancy.

“Norton Women’s Care has recommended to all providers low-dose aspirin therapy for all pregnant women at risk for hypertensive disorders of pregnancy and/or preeclampsia to prevent this complication,” said Lyndsey D. Neese, M.D., MMM, FACOG, OB/GYN with Norton Women’s Care and medical director of quality for women’s services at Norton Healthcare.

Dr. Neese leads Norton Women’s Care’s initiative to supply low-dose aspirin during pregnancy to prevent or delay the onset of preeclampsia in our patients.

Recommendations: low-dose aspirin (LDA) in pregnancy

The American College of Obstetricians and Gynecologists (ACOG) recommends daily low-dose aspirin (81 milligrams per day) for all women at risk for pre-eclampsia. Prophylaxis should begin between 12 weeks and 28 weeks of gestation (optimally before 16 weeks) and continued daily until delivery.

High risk factors for preeclampsia include at least one of the following:

• History of preeclampsia, including:
  • Early-onset preeclampsia and preterm delivery at less than 34 weeks
  • More than one prior pregnancy complicated by preeclampsia
• Chronic hypertension
• Diabetes (Type 1 or Type 2)
• Renal disease
• Autoimmune disease
• Multifetal gestation

Moderate risk factors for preeclampsia include more than one of the following:

• First pregnancy
• Age 35 or older
• Body mass index (BMI) greater than 30
• Family history of preeclampsia
• Complications in a previous pregnancy
• Sociodemographic characteristics
  • Black and/or lower-income patients are at greater risk.

Patients already receiving medically-indicated low-dose aspirin for other established conditions prior to 12 to 28 weeks can continue their low-dose aspirin treatment.

Administering LDA therapy earlier in pregnancy (prior to 11 weeks) does not decrease the risk of preeclampsia or other hypertensive disorders among high-risk women, according to a study.

Patients with a history of aspirin allergy, hypersensitivity to other salicylates/nonsteroidal anti-inflammatory drugs (NSAIDs), nasal polyps or asthma with aspirin-induced acute bronchospasm should not receive LDA therapy in pregnancy.

“Our baseline rate of LDA prescribing/documentation of the patient taking LDA in Epic in 2020 was 11%,  and with education and reminders to providers, it has increased to 41% as of October 2022,” Dr. Neese said.