Thursday, September 22, 2016

Low-dose aspirin for all pregnant women?

The American Journal of Obstetrics and Gynecology just printed an article arguing that it is probably beneficial to recommend that all pregnant women take low-dose aspirin in the first trimester in order to head off pre-eclampsia. Here's the abstract:

Low-dose aspirin has been demonstrated to reduce the incidence of pre-eclampsia and fetal growth restriction (FGR) in at-risk populations. Its’ role in low-risk populations is as yet unknown. Novel pre-eclampsia screening tests are emerging which can predict the risk of developing pre-eclampsia from as early as 11-weeks’ gestation. It may be more efficacious, acceptable and cost effective to prescribe low dose aspirin to all pregnant women from the first trimester as opposed to performing a screening test in the first instance. There is variation in opinion; the American College of Obstetricians and Gynecologists suggest use of aspirin only in women at risk of pre-eclampsia based on history taking, while the National Institute for Health and Clinical Excellence, UK and the U.S. Preventative Services Task Force recommend use if there is one major or two moderate risk factors. This point-counterpoint discussion shall address; (i) controversies regarding the real impact of low dose aspirin; (ii) controversies in the actual guidelines amongst the different national societies; (iii) controversies regarding emerging pre-eclampsia screening tests in terms of cost-effectiveness and efficacy and (iv) points in favour of the provision of universal versus screened-positive women.

Isn't this a bit premature considering we still don't know why preeclampsia happens? The first trimester is such an important time in fetal development, and even low-dose aspirin use can cause side effects like upset stomach, heartburn, and even stomach bleeding (just what a pregnant woman wants--morning sickness with blood in the vomit). Moreover, wouldn't it be safer and healthier to recommend pregnant women eat more foods with naturally occurring salicylates? (Here's a compilation of such foods - Peppermint tea is high in salicylates, which is convenient for first trimester mothers, for peppermint oil also helps speed up gastric emptying, per By utilizing high-salicylate foods in place of aspirin, we avoid the corrosive acetic acid from aspirin, which decomposes into acetic acid and salicylic acids, per Wikipedia.

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