Low-dose aspirin (LDA) prophylaxis during pregnancy can prevent, delay preeclampsia

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

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.

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To refer a patient to Norton Women’s Care, visit Norton EpicLink and choose EpicLink referral to Obstetrics/Gynecology.

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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.

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