Can a pregnant woman take Baby Aspirin (acetylsalicylic acid)?

From the Guidelines

It is recommended to take baby aspirin during pregnancy only under medical supervision and for women at high risk of preeclampsia or other specific medical conditions, as stated by the U.S. Preventive Services Task Force recommendation statement 1. When considering taking baby aspirin while pregnant, it is crucial to consult with a healthcare provider first. Some specific cases where doctors may prescribe low-dose aspirin (typically 75-81 mg daily) during pregnancy include:

• Women at high risk of preeclampsia, such as those with a history of hypertension in a previous pregnancy, chronic kidney disease, autoimmune disease, type 1 or 2 diabetes, or chronic hypertension 1
• Women with more than one moderate-risk factor, including first pregnancy, age ≥40 years, pregnancy interval >10 years, body mass index ≥35 kg/m2, family history of preeclampsia, or multifetal pregnancies 1 The timing of when to start and stop taking baby aspirin during pregnancy varies based on individual circumstances, but it's often recommended from 12 weeks until delivery, as suggested by the National Institute for Health and Care Excellence and the American Heart Association 1. Aspirin works by inhibiting blood clotting and reducing inflammation, which can be beneficial in preventing placental issues in high-risk pregnancies. However, it also carries potential risks, including increased bleeding, so self-medication during pregnancy is not advised, and regular-strength aspirin should be avoided entirely during pregnancy as it poses greater risks to both mother and baby.

From the FDA Drug Label

If pregnant or breast-feeding ask a health professional before use. it is especially important to use aspirin during the last 3 months of pregnancy unless definitely directed to do so by a doctor because it my cause problems in the unborn child or complications during delivery.

• Aspirin use during pregnancy is not recommended, especially during the last 3 months, unless directed by a doctor.
• It is advised to consult a health professional before taking aspirin while pregnant.
• The use of aspirin during pregnancy may cause problems in the unborn child or complications during delivery 2.

From the Research

Aspirin Use During Pregnancy

• The American College of Obstetricians and Gynecologists recommends daily low-dose aspirin beginning in the late first trimester for women with a history of early-onset preeclampsia and preterm delivery at less than 34 0/7 weeks of gestation, or for women with more than one prior pregnancy complicated by preeclampsia 3.
• Low-dose aspirin (81 mg/day) prophylaxis is recommended in women at high risk of preeclampsia and should be initiated between 12 weeks and 28 weeks of gestation (optimally before 16 weeks) and continued daily until delivery 3.
• There is general agreement in the reported indications for aspirin intake in pregnancy, with prior preeclampsia and maternal medical co-morbidity associated with increased risk of preeclampsia being the major indications for aspirin intake 4.

Safety and Efficacy

• Daily low-dose aspirin use in pregnancy is considered safe and is associated with a low likelihood of serious maternal, or fetal complications, or both, related to use 3.
• Low-dose aspirin has been demonstrated to reduce the incidence of preeclampsia and fetal growth restriction in at-risk populations 5.
• The combined supplementation of aspirin and calcium starting at 20-27 weeks of gestation produced a nonsignificant decrease in the incidence of superimposed preeclampsia and fetal growth restriction in hypertensive women with abnormal uterine artery Doppler 6.

Guidelines and Recommendations

• The U.S. Preventive Services Task Force published a guideline recommending daily low-dose aspirin use for the prevention of preeclampsia in women with a history of preeclampsia, chronic hypertension, or other risk factors 3, 5.
• The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine support the U.S. Preventive Services Task Force guideline criteria for prevention of preeclampsia 3.
• There is variation in opinion regarding the use of aspirin in low-risk populations, with some guidelines recommending universal aspirin use and others recommending screening tests to identify high-risk women 5.