May is Preeclampsia Awareness Month, a time dedicated to shedding light on a serious pregnancy complication that affects thousands of women each year. Preeclampsia is a hypertensive disorder that can occur during pregnancy and the postpartum period, posing risks to both mother and baby. Raising awareness and encouraging open conversations with healthcare providers are crucial steps in improving outcomes.
Preeclampsia is characterized by high blood pressure and often, but not always, the presence of protein in the urine. It typically develops after 20 weeks of pregnancy, though it can occur earlier or even after delivery (postpartum preeclampsia). Symptoms can vary and may include:
- Severe headache that doesn’t go away
- Vision changes, such as blurriness, flashing lights, or seeing spots
- Swelling in the face and hands
- Upper abdominal pain, usually under the ribs on the right side
- Nausea or vomiting later in pregnancy
- Sudden weight gain
- Shortness of breath
It’s important to note that some swelling in the feet and ankles is common in pregnancy and doesn’t necessarily indicate preeclampsia. However, any sudden or severe swelling, especially in the face and hands, should be reported to your doctor.
Left untreated, preeclampsia can lead to serious complications for both mother and baby, including:
- Stroke
- Seizures (eclampsia)
- HELLP syndrome (a severe form of preeclampsia affecting the liver and blood)
- Placental abruption (separation of the placenta from the uterus)
- Restricted fetal growth
- Preterm birth
The Role of 81mg Aspirin in Prevention
Recent guidelines from organizations like the American College of Obstetricians and Gynecologists (ACOG) and the U.S. Preventive Services Task Force (USPSTF) recommend1 the use of low-dose aspirin (typically 81mg) daily for individuals at high risk of developing preeclampsia. This recommendation is based on evidence that starting low-dose aspirin in the late first trimester (ideally before 16 weeks) and continuing until delivery can help reduce the risk of preeclampsia and its associated complications.
Individuals considered at high risk for preeclampsia include those with:
- A history of preeclampsia, especially with severe features or preterm delivery
- Multiple gestation (carrying twins, triplets, etc.)
- Chronic hypertension
- Type 1 or Type 2 diabetes
- Kidney disease
- Autoimmune diseases (such as lupus or antiphospholipid syndrome)
Additionally, those with more than one moderate risk factor may also benefit from low-dose aspirin. Moderate risk factors can include:
- Being pregnant for the first time
- Obesity (BMI > 30)
- Family history of preeclampsia (mother or sister)
- Maternal age 35 or older
- Certain social and demographic factors, including Black race (which is linked to higher risk due to systemic inequities, not biological factors)
- A pregnancy interval of more than 10 years
Why the Conversation is Crucial
It’s been observed that not all pregnant individuals, even those who are later diagnosed with preeclampsia, recall discussing the option of 81mg aspirin with their healthcare providers. There could be several reasons for this. The recommendation for aspirin is risk-based, so it may not be discussed with individuals who are initially assessed as low risk. Variations in clinical practice, time constraints during appointments, or a focus on other aspects of prenatal care could also play a role.
However, every expectant mother deserves to be informed about potential risks and preventive measures relevant to their individual health profile. This is where your voice as a patient becomes incredibly powerful.
Empowering Yourself: Ask Your Doctor
As a new or expectant mother, you are your own best advocate. During your prenatal appointments, don’t hesitate to ask your doctor about your individual risk factors for preeclampsia. Discuss your medical history, family history, and any concerns you may have.
Specifically, ask your doctor if low-dose 81mg aspirin is recommended for you based on your risk factors. If it is, discuss when you should start taking it and continue the conversation throughout your pregnancy.
Postpartum Preeclampsia: The Risk Doesn’t Always End at Delivery
It’s also vital to be aware that the risk of preeclampsia doesn’t disappear immediately after giving birth. Postpartum preeclampsia can occur, most commonly within the first 48 hours after delivery, but it can develop up to six weeks or even later postpartum. The symptoms are similar to those during pregnancy, and prompt medical attention is crucial if you experience any of them after your baby is born. Be sure to discuss the signs and symptoms of postpartum preeclampsia with your healthcare provider before you leave the hospital and know when to seek immediate care.
In Conclusion
Preeclampsia Awareness Month in May is a perfect opportunity to highlight the importance of this condition and empower expectant and new mothers. By understanding the symptoms, knowing your risk factors, and having open and proactive conversations with your healthcare provider about preventive measures like low-dose aspirin, you are taking vital steps to protect your health and the health of your baby. Don’t hesitate to ask questions, share your concerns, and advocate for the care you need. Your health matters.
