Preventing preeclampsia: What we know about aspirin and preeclampsia

About one in three pregnant individuals may develop a complication that fits under an umbrella of conditions that we call “placenta-mediated adverse outcomes.”

The frequency of these complications in pregnancy is increasing, and they may carry severe short- and long-term risks for pregnant people and their children both. Among these complications are conditions like preeclampsia, gestational hypertension, preterm birth, fetal growth restriction, gestational diabetes, fetal demise and others.

What is preeclampsia?

Preeclampsia, specifically, is a condition that can cause potentially fatal spikes in a pregnant person’s blood pressure and damage the kidneys or other organs. Combined with gestational hypertension, these hypertensive disorders of pregnancy affect up to 15% of pregnant individuals. The frequency and severity of these conditions is increasing, especially among Black and other minority populations.

These conditions can cause immediate complications, such as severe hypertension (severely high blood pressure), kidney and liver injury, brain bleed, seizures and others. For the baby, it can cause complications related to abnormal growth and premature birth, along with its myriad complications.

However, the impact of preeclampsia and gestational hypertension isn’t limited to the short-term. We know that people who develop preeclampsia are at increased risk of heart disease, hypertension, stroke and premature death from these conditions. Their children — especially if born early in the setting of a hypertensive disorder — are at increased risk of developing diabetes, obesity, cardiovascular disease and hypertension later in their life.

Additionally, preeclampsia carries a huge economic cost. A study found that preeclampsia-related care costs in the first year after birth in the U.S. health system surpass $2 billion per year.

How we treat preeclampsia

The only cure for preeclampsia is to deliver the baby and placenta — however, that’s not ideal in many occasions, and it can lead to premature birth. With no medications to treat preeclampsia, attention has focused on prevention, and the only approved therapy for that is low-dose aspirin, which has been shown to reduce the risk of developing preeclampsia by around only 15%.

Should pregnant people take aspirin?

Pregnant people who have at least one major or two minor risk factors for preeclampsia should take aspirin in pregnancy (unless contraindicated for other reasons).

Major risk factors include:

• diabetes
• multifetal pregnancy
• hypertension
• renal disease
• certain autoimmune diseases
• prior pregnancy that was affected by preeclampsia

Minor risk factors include:

• being in your first pregnancy
• pregnancy following in-vitro fertilization
• body mass index (BMI) higher than 30
• personal history of pregnancy complications
• family history of preeclampsia
• identifying as Black

Talk to your doctor about whether you qualify to receive aspirin in pregnancy. Although aspirin is generally considered safe, aspirin can increase your risk of bleeding in some cases.

New research into treatment for preeclampsia

The Ohio State University Wexner Medical Center is part of a multi-year study to determine whether a higher dose of aspirin can reduce the frequency of hypertensive disorders and improve maternal and neonatal outcomes.

Here and at 11 other clinical centers nationwide, we intend to enroll a total of more than 10,000 pregnant people who are at higher risk of developing hypertensive disorders of pregnancy.

In this study, we’ll randomize participants into two groups using two “low-dose” aspirin regimens. People will be followed until six weeks after giving birth, assessing for whether they developed hypertensive disorders as well as the overall health of the participants and their babies.

The study, which received grant funding from Patient Centered Outcomes Research Institute (PCORI), will run through 2028.

We’re also conducting a second study to help understand why patients may respond differently to aspirin at the different doses by examining extracellular vessels — small particles released from the placenta that carry information on placental health.

We’re examining the cargo within these vessels in hopes of identifying proteins that would tell us whether the patient is at risk of developing preeclampsia and/or responding to aspirin therapy. This study also runs until 2028, with results to follow.