Use of Low-Dose Aspirin in Pregnant Women with Rheumatoid Arthritis
Low-dose aspirin is not routinely recommended for pregnant women with rheumatoid arthritis alone, but may be considered based on individual risk factors for preeclampsia. 1
Recommendations for Aspirin Use in Pregnancy with Rheumatoid Arthritis
The 2020 American College of Rheumatology (ACR) guidelines provide clear direction regarding aspirin use during pregnancy in women with rheumatic diseases:
When ASA IS Recommended:
- For women with Systemic Lupus Erythematosus (SLE): Low-dose aspirin (81 or 100 mg daily) is conditionally recommended beginning in the first trimester 1
- For women with Antiphospholipid Syndrome (APS): Low-dose aspirin combined with prophylactic-dose heparin is strongly recommended 1
When ASA is NOT Routinely Recommended:
- For women with rheumatoid arthritis (RA) without additional risk factors for preeclampsia 1
Risk Assessment for Preeclampsia
The ACR guidelines state that "low-dose aspirin during pregnancy to prevent or delay the onset of gestational hypertensive disease is recommended for those with SLE or APS because of their increased risk and may be considered for women with other RMD diagnoses depending on individual clinical risk factors." 1
Risk factors that might warrant aspirin use in RA patients include:
- History of preeclampsia
- Multifetal pregnancy
- Chronic hypertension
- Type 1 or 2 diabetes
- Renal disease
- Advanced maternal age
Dosing and Timing
If aspirin is indicated based on preeclampsia risk:
- Recommended dose: 81-100 mg daily 1
- Begin in the first trimester
- Continue until delivery, unless obstetrician recommends discontinuation prior to delivery for anesthetic considerations 1
Safety Considerations
- Low-dose aspirin is generally considered safe during pregnancy when indicated
- FDA labeling notes caution with aspirin use in the last trimester of pregnancy unless specifically directed by a physician 2
- The decision regarding discontinuation prior to delivery should be made by the obstetrician and anesthesiologist based on the patient's specific situation 1
Management of RA During Pregnancy
For management of RA during pregnancy, the following medications are considered safer options:
Conclusion
The presence of rheumatoid arthritis alone does not warrant the use of aspirin during pregnancy. However, if a pregnant woman with RA has additional risk factors for preeclampsia, low-dose aspirin (81-100 mg daily) beginning in the first trimester should be considered as part of her prenatal care.