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Baby aspirin & pregnancy

Shieva Ghofrany: [00:00:00] It's Thursday. I say that like it's so amazing. I don't know why I just said that, but I'm saying it. So it's Thursday, we're gonna talk about low dose aspirin for decrease risk of severe pre-eclampsia or what we call pre-eclampsia with severe features nowadays. Again, not a glamorous topic, but very important. 

So a couple housekeeping detail. Yes, I have mask knee. It's very annoying. I have not had a pimple like this in a long time and I tried to operate last night and it was not pleasant. So there you have it. It will be covered up soon when I put on my mask and create more friction. Um, pre-eclampsia, many of you might have heard of it, is when the situation occurs in pregnancy with high blood pressure. 

Swelling, what we call edema and often protein in the urine proteinuria, which is why every time you go to the doctor's office and you're pregnant, you get your blood pressure checked, you get your urine dipped, and they choke. They often will look or ask about your legs and hands and feet. It's very common to have [00:01:00] swelling towards the end of the pregnancy as. 

Especially in your first time, it's not uncommon for your blood pressure to go up a little bit towards the end of the pregnancy. It is very manageable to have preeclampsia, especially when it is of the milder variety, meaning blood pressures that are not very high, mild swelling, a little bit of protein in the urine, or no protein in the urine, and we see it a lot and we are not. 

Fearful. I'm not fearful of things. We're not fearful of it because we really try to proactively take care of it, but we really do have to be very mindful of it because it can cause a lot of problems. So it's not one of those things where we can be blase and say, oh, pre-eclampsia is not a big deal. It's actually a very big deal, and probably one of the leading causes of. 

Mortality and morbidity, meaning problems in pregnancy with moms and babies. So while I always want to defray anxiety and decrease, um, nerves, I also have to say we have to take preeclampsia very seriously because we know the data and we [00:02:00] know that it can cause harm. Can we address it appropriately? Of course. 

So outside of, again, entering the pregnancy, ideally in your best health, Lower weight because decreased weight decreases the likelihood of underlying hypertension, which decreases the chance of pre-eclampsia is one thing that we can all try to do. That is not the only thing, and that is not one of the only risk factors. 

Even thin women with no history of hypertension can develop pre-eclampsia, but of course, coming into it with a low weight and making sure that you try to exercise during your pregnancy are good. As far as one other beautifully impactful, um, measure that we can take that is so simple. The American College of ob GYN has come out with newer guidelines to enhance what we've already done. 

Even in the last 21 years since I've been a physician, we have been given giving patients low dose baby aspir, I mean low dose aspirin, what we call baby aspirin to decrease the chance of severe pre-eclampsia. Baby aspirin is a misnomer because babies can no longer [00:03:00] take aspirin, but it was the. Decades ago that they used to give babies, do not give your baby aspirin because babies cannot take aspirin. 

That said, when they came out with these guidelines, we were all very excited because now we can expand the number of women who can take low-dose aspirin, what I will call baby aspirin. But the guidelines are a little bit complicated, so we constantly have to refer to our chart to make sure that we are hitting the right number of people and we, I fully acknowledge. 

Still deficient in making sure that all the patients in any given practice in our practice certainly are taking their low dose aspirin. So I think that within the next one to three years, the ob gyn community will get up to speed. But these guidelines are still fairly new. So many of your doctors might not have done this yet. 

Do not disparage them. It doesn't mean they're not up to date. It just means it's new for all of us. Our practice has tried to be more mindful about trying to get every single patient that fits this category, but it's. And then you will see why in a second, because the guidelines are not completely easy to just remember off the [00:04:00] top of your head. 

I, in fact, have said maybe we need to have a bullet pointed list of the people who shouldn't be on it because it seems like fewer people don't qualify than do qualify. But first, a couple of things. Pre-eclampsia falls into several categories, but the two broad ones for the ease of this discussion. 

Pre-eclampsia that is considered milder versus pre-eclampsia, that is considered more severe. Our concern with pre-eclampsia is that it can lead to eclampsia, which is when the woman has a seizure, and that it can affect the placenta, which is actually the cause of the pre-eclampsia as well. And it can lead to things like growth restriction for the baby, or what is called an abruption, where the placenta shears off too quickly. 

And so it really can be a concern for mom. pre and the infant. The way to cure the pre-eclampsia is actually to deliver the baby and have the placenta come out. As you can imagine, if we discover the pre-eclampsia very early, it can be detrimental to deliver the baby very early. So we really have tried to come up with [00:05:00] measures that will decrease. 

Severe pre-eclampsia, especially early in the pregnancy when the baby is considered preterm. So when we were going through residency, the easy patients to tell to take baby aspirin would be those who had a history of 28 weeks severe pre-eclampsia, or a variant called help, which is where their liver enzymes were elevated and their platelets. 

Those cells that make your blood sticky, platelets were low. Those were easy patients to say, oh, before your next pregnancy, Or during the early first trimester of your next pregnancy, start taking baby aspirin. It will decrease the chance of severe pre-eclampsia. You might still get mild pre-eclampsia, which is very manageable, but it will decrease the risk of severe pre-eclampsia. 

Now again, the guidelines have widened, so first and foremost, I want you to be mindful that pre-eclampsia can be managed, but you have to be on the ball, you and your doctor about understanding little things and knowing the symptoms. So I think it's wise for you to never panic, because like I said, [00:06:00] never in the history of ever is panicking. 

Good for you, but be proactive. So I'm gonna list a couple of things that I want you guys to just think about and know about. Second, if you are in a situation now, especially with Covid, where you're choosing to. Um, miss some of your pregnancy visits, which I can't say I would necessarily advocate unless you have absolutely talked to your doctor about your risk factors. 

And if it's appropriate, you still need to be mindful about the things that you can do to know when to call the doctor. Third, pre-eclampsia is not something to be. Feared exactly, but we have to take it seriously. We really do. Because again, if we don't take it seriously, then we can't be optimistic. If we are proactive in trying to mitigate the risk and catching it when it happens, then we can be optimistic. 

So the two-pronged approach is ideally trying to prevent it, but that's not always possible. But also trying to catch it as early as possible to make sure that the mom and the baby are safe. Okay, so preeclampsia again is when the blood pressure. . You often have protein and you often have swelling, but it's not necessarily all of [00:07:00] those things. 

The things that I want patients to know about, though, I kind of joke that I probably don't need to tell you these severe symptoms because they're so extreme that most patients would know to call their doctor. That said, occasionally I've had a patient who did not call for several hours and later said, I just thought it was normal. 

Headache. Headaches are normal in pregnancy, but if you feel like your head is gonna explode, call your doctor Heartburn. Heartburn is common in pregnancy, but if you feel like you have searing pain that goes through, that does not get resolved. When you take one of those antacids and it's new onset, call your doctor. 

Rib pain pretty common in pregnancy, but if you feel like you have sudden onset, like you think there's someone, put a knife underneath the right upper quadrant, right underneath your. You call your doctor. Floaters very common in pregnancy, but if you think you're seeing fright, flashing lights, you call your doctor. 

Those are signs of severe preeclampsia that we would be concerned about. Okay? Other things would be all of a sudden I woke up and my husband said, your face looks so swollen. What's going on? You've suddenly gained 10 pounds in three days of retained water weight. So again, things that are [00:08:00] not subtle, absolutely call your doctor. 

Things that are subtle tend to be less severe, but if you are worried, you should absolutely contact your doctor and ask. Okay. Getting back to the baby aspirin, baby aspirin. If we start it, the guidelines say start between 12 weeks and 28. Ideally by 16 weeks, again, not all the doctors have yet adapted these guidelines and that's okay cuz they're still newer. 

We are trying to be more mindful about adapting them. Even in these more subtle circumstances. The obvious ones, I think doctors across the country and world have have been doing patients who had had a previous history of severe preeclampsia. Patients who have had a previous history of help syndrome. 

Patients who have already. Preexisting hypertension. Those are kind of obvious ones, but the list is expanded and they've stratified it into two groups, the groups that have higher risk categories, and the groups that have mild, and I actually have them pulled up here so that I can go through them because even me with my memory, which is decent, cannot remember all of these, so we're gonna go through them. 

The high risk category means if you have even one risk factor, [00:09:00] you are to start your low dose aspirin. So if you have your own personal history of pree clamps, You take low dose aspirin if you have twins, diabetes of either type, type one or type two, or a personal history of hypertension. Preexisting meaning you come into the pregnancy with hypertension, not pre-eclampsia even. 

Then you take it, okay, so let's just review those easy, obvious ones. I have hypertension. I have diabetes, I have twins, or I had pre-eclampsia. I am to take baby aspirin or if I have any kidney. Or if I had an autoimmune disorder, that makes me more likely to have things like blood clots or problems with my kidneys, like lupus or antiphospholipid antibody syndrome. 

Those are clear indications where you take a baby aspirin if you have even one of those risk factors. Those ones are simple for us to remember. The harder ones are these moderate risk factors where if you have two or more, it is suggested. This is how they, they word it consider low dose aspirin if the patient has more than one of these moderate [00:10:00] risk factors. 

Okay? Which means if you have two risk factors, we should consider it, which is why it's not standard yet for everyone to. But I deeply believe it should be, and I think it's something you should at least discuss with your doctor. I'm not saying that they will necessarily do it, and they're not wrong if they don't, but I think it's a simple intervention that is found to be very safe. 

So moderate risk factors. Keep in mind you need two of these. If it's your first baby, if you have a bmi, a body mass index over 30. If you have a family history where your mother or your sister had pre-eclampsia, if you are black or of low socio. Status, either or if you are over 35, if you had a personal history of having a low birth weight or a small for gestational age baby, or a previous adverse pregnancy outcome, which by the way is a very broad word, they really mean things like if you had an abruption or you had a growth restricted baby, or more than a 10 year interval between your pregnancies. 

So any of those things. In my preface pregnancy, my first child was growth [00:11:00] restricted. So in my second P. I took baby aspirin. I actually took it for all of mine because of other reasons that at the time were not indicated, but I took it anyway. Um, so again, if you had two or more of. Then you're gonna go ahead and take baby aspirin. 

Should everyone take it? I personally think so, though. I am not your doctor, but the ACOG guidelines would allow for it. So you should speak to your doctor. Is it safe? Yes. Multiple data points. Multiple studies have shown it to be safe. Do you take it for your entire pregnancy till the end? You do. We used to stop at 35 or 36 weeks to avoid bleeding. 

They have now found that you can. Straight through the end of the pregnancy with no effect on the epidural or spinal or bleeding. It does not affect the fetus. It does not cause birth defects. It is a very simple, cheap. Intervention that is being used worldwide. In fact, in England, they're using a slightly higher dose than our baby dose of aspirin, which is 81 milligrams here in America. 

So again, I know it's not a fun, glamorous topic, but it's important and you guys are always asking about things you can do to improve health and improve pregnancy outcomes. So, [00:12:00] Talk to your doctor about low-dose aspirin. I'm gonna put a screenshot of these guidelines in my stories so that you guys can understand and read about it. 

Um, and I think if we can increase the availability of knowledge for something simple like this, even those of us as physicians who sometimes forget because we're busy and there's millions of things going on in our day. , then maybe you bring it to our attention and say, Hey, what do you think about low-dose aspirin? 

Those patients where I might forget that they fall into that category because they seem otherwise completely stable and healthy, but I've forgotten that they're 35 and their BMI might be 30 and I might look at her and not even remember that her BMI is 30. She might be a great candidate for it. Okay, so I hope that helps. 

Um, I hope you have a great day. I'm gonna go tend to my little pimple and put a little cover up, but maybe not because I'm gonna put on a mask and that is all folks. See you later. My.