Should Women Who Had Pre-eclampsia Take Aspirin After Giving Birth?
No, aspirin should be discontinued at delivery and is not recommended for postpartum use in women with a history of preeclampsia. The evidence and guidelines consistently recommend aspirin prophylaxis during pregnancy until delivery, but there is no established indication for continuing aspirin after giving birth 1, 2.
Aspirin Timing: During Pregnancy Only
The critical window for aspirin's protective effect is during pregnancy, not postpartum:
- All major guidelines recommend continuing aspirin until delivery, not beyond 1, 2
- The American College of Obstetricians and Gynecologists specifically states that low-dose aspirin should be "continued daily until delivery" for preeclampsia prevention 2
- Multiple international guidelines from Canada, Ireland, New Zealand, the USA, and the UK specify continuation until delivery as the endpoint, with no recommendation for postpartum continuation 1
Why Aspirin Works During Pregnancy But Not After
The mechanism of aspirin's benefit is tied to placental pathophysiology:
- Defective placentation and inadequate spiral artery remodeling occur in the first trimester, and aspirin initiated early improves uteroplacental blood flow during the critical period of placentation 1
- Once delivery occurs and the placenta is removed, the pathophysiologic basis for aspirin's protective effect no longer exists 1
- The anti-inflammatory, antiangiogenesis, and antiplatelet properties of aspirin specifically target placental ischemia and abnormal placentation 3
For Your Next Pregnancy: When to Start Aspirin
Since you have a history of postpartum preeclampsia and are now 8 weeks pregnant:
- Start low-dose aspirin immediately (between 12-16 weeks of gestation, optimally before 16 weeks) 1, 2
- The recommended dose is 100-150 mg daily (not the standard 81 mg), as emerging evidence suggests higher doses are more effective 1, 4
- Continue daily until delivery of this current pregnancy 1, 2
Specific Dosing for Your Situation
- History of preeclampsia is a high-risk factor that warrants prophylactic aspirin therapy 5, 2
- The U.S. Preventive Services Task Force and American College of Obstetricians and Gynecologists endorse aspirin as a Grade B recommendation for women with prior preeclampsia 1, 5
- Consider 100-150 mg daily rather than 81 mg, as meta-analyses demonstrate that aspirin doses ≥100 mg initiated before 16 weeks are significantly more effective (RR 0.33,95% CI 0.19-0.57, p<0.0001) 1, 4
Safety Profile
Low-dose aspirin during pregnancy has an excellent safety record:
- No increased risk of placental abruption, postpartum hemorrhage, fetal intracranial bleeding, perinatal mortality, or congenital anomalies 1, 5, 2
- Safe to continue until delivery without stopping at 36 weeks 1
Common Pitfall to Avoid
Do not confuse the timing of aspirin for preeclampsia prevention (during pregnancy) with aspirin for cardiovascular disease prevention (which may be lifelong). The indication for aspirin in pregnancy is specifically to prevent preeclampsia by improving placentation, which is only relevant while pregnant 3, 1.