When should I stop taking Ecospirin (aspirin) 75mg during pregnancy?

When to Stop Ecospirin (Aspirin) 75mg in Pregnancy

Continue Ecospirin 75mg daily until delivery at term. 1, 2, 3

Primary Recommendation

The American College of Obstetricians and Gynecologists (ACOG) explicitly recommends that low-dose aspirin initiated for preeclampsia prevention should be continued daily until delivery. 2, 3 This is the standard of care supported by multiple international guidelines, including recommendations from Canada, Ireland, New Zealand, the USA, and the UK. 4

Supporting Evidence and Rationale

Duration of Therapy

• Most guidelines specify continuation until delivery rather than stopping at a predetermined gestational age. 4, 1
• Some European guidelines suggest not stopping before 35-37 weeks at the earliest, but the predominant recommendation is to continue through delivery. 4
• The rationale is that preeclampsia risk persists throughout pregnancy and even into the early postpartum period, with eclamptic seizures potentially developing for the first time after delivery. 4

Safety Profile Through Delivery

• Low-dose aspirin (75-81mg) does not increase risks of:
  • Placental abruption 4, 1
  • Postpartum hemorrhage 4, 1
  • Fetal intracranial bleeding 4, 1
  • Perinatal mortality 4, 1
• The safety profile remains favorable when continued until delivery. 2, 3

Special Circumstances Requiring Earlier Discontinuation

Planned Cesarean Section with Neuraxial Anesthesia

If a planned cesarean section with spinal/epidural anesthesia is scheduled, aspirin should be discontinued 7-10 days before the procedure to allow adequate platelet function recovery. 5

Algorithm for planned C-section:

• Stop aspirin 7-10 days before scheduled surgery 5
• Check platelet count if any signs of preeclampsia or platelet concerns 5
• Ensure platelet count >75 × 10⁹/L before spinal anesthesia 5
• Do not restart until 24 hours post-surgery 5

Spontaneous Labor at Term

For spontaneous labor at term without planned neuraxial procedures, continue aspirin until labor begins. 1, 2, 3 There is no need to stop aspirin in anticipation of spontaneous labor, as the benefits of continued prophylaxis outweigh theoretical bleeding risks. 4

Common Pitfalls to Avoid

• Do not stop aspirin at 36 weeks "just to be safe" - this is not evidence-based and removes protection during a high-risk period. 4, 1
• Do not confuse low-dose aspirin (75-81mg) with high-dose aspirin - the FDA warning about aspirin in the third trimester refers to high doses (>100mg), not prophylactic low doses. 6
• Do not stop abruptly without a specific indication - preeclampsia risk continues through delivery and the early postpartum period. 4

Your Specific Case at 8 Weeks

At 8 weeks gestation with a positive pregnancy test after FET, you should:

• Continue Ecospirin 75mg daily without interruption 1, 2, 3
• Plan to continue through the remainder of pregnancy until delivery 1, 2, 3
• Only consider stopping 7-10 days before delivery if a planned cesarean section is scheduled 5
• Otherwise, continue until spontaneous labor or induction of labor at term 1, 2, 3