Reducing the risk of pre-eclampsia and growth problems with your baby

You have received this information as it has been recommended that you take aspirin 150mg once a day from 12 weeks of pregnancy onwards.

Why have I been recommended to take aspirin in my pregnancy?

• Your Midwife or Doctor has assessed your medical and/or pregnancy history and it has been found that you are at risk of having a small baby and/ or developing preeclampsia (see information below).
• Research suggests that taking aspirin in pregnancy reduced the risk of developing pre-eclampsia by two thirds (about 60-70%). However, aspirin will not protect everyone from developing pre-eclampsia.
• Taking aspirin in pregnancy may also help reduce your chance of giving birth to your baby prematurely (before 37 weeks) and of your baby being smaller than expected. There is evidence that taking aspirin in pregnancy increases the function and blood flow through your placenta (your placenta is the organ that provides your baby with the oxygen and nutrients to support them to grow).

What is pre-eclampsia?

Pre-eclampsia is a condition that only occurs in pregnancy. It affects around 2-10 in every 100 pregnancies (about 2-10%).

Although the exact cause of pre-eclampsia is not known, it’s thought to happen when there is a problem with the placenta.

Pre-eclampsia causes raised blood pressure (hypertension) and protein in the urine.

Pre-eclampsia often occurs without symptoms but if they do occur, they include severe headaches, visual disturbance (blurred or flashing in their vision) and swelling to the hands, feet and face. 

In most cases pre-eclampsia is only mild pre-eclampsia but sometimes it can be more severe with the risk of serious complications for you or your baby. There is a risk you could develop fits called eclampsia. These fits can be life threatening for your or your baby, but they are rare.  

Who can get pre-eclampsia?

Anyone can develop pre-eclampsia but there are factors the can increase your risk. These risk factors are divided into two categories of Moderate Risk factors and High-Risk factors.

If you have two or more moderate risk factors or one high risk factor, it is recommended you take aspirin from 12 weeks of pregnancy until the birth of your baby.

You may also be advised to take aspirin for other reasons and your Midwife or Doctor will discuss this with you.

Is aspirin safe to take in pregnancy?

Research has shown that aspirin is safe in pregnancy and does not cause any harm to a baby’s development or increase the risk of bleeding during pregnancy.

Taking aspirin to reduce the risk of pre-eclampsia and/ or having a small baby during pregnancy is an unlicensed use of the drug. The use of unlicensed medication in pregnancy is extremely common.

Before taking aspirin, please speak to your Midwife or Doctor if you have any of the following:

• Allergic to aspirin (or other non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen).
• Severe asthma.
• Chronic kidney problems.
• Stomach ulcers.
• Have previously been advised not to take aspirin or NSAIDs.

Does aspirin cause side effects?

Aspirin can cause mild indigestion (discomfort or a burning feeling in your upper stomach, bloating or feeling sick). This affects about 1 in 100 people (about 1%).  The chance of having mild indigestion is reduced if aspirin is taken with food or just after food. Avoid taking aspirin when your stomach is empty.

If you take any remedies to reduce indigestion, remember, not take them 2 hours before or after your aspirin.

If the side effects of aspirin are making it difficult to be able to take it, then please contact your Midwife, Doctor or the Antenatal Clinic.

As with any medicine, you should seek immediate medical assistance if you experience any serious side effected such a wheezing, sweeling in your lips, face or body, rashes or other signs of an allergic reaction.

How and when do I take aspirin?

You should take 150mg (2x 75mg tablets) once a day at night from 12 weeks until the birth of your baby. There is research to suggest its works best if taken in the evening with or just after food.
If you forget a dose of you aspirin don’t worry, just take it once you have remembered but remember to only take one dose of 150mg a day. The aspirin can be prescribed by your GP or Obstetrician.

Is there anything else I can do to help? 

If you smoke tobacco it is important that you stop as it can affect how well the placenta works and this could affect the growth of your baby. If you would like support to stop smoking, please contact your Midwife who can refer you to the Smokefree Pregnancy Team at Leighton Hospital. Alternatively you can self-refer on the Smokefree Pregnancy Page.

Other sources of information

If you have any other questions or wish to discuss taking aspirin in your pregnancy, then your Midwife or Doctor will be happy to answer any questions you have. 

•    Best use of Medicines in Pregnancy website: www.medicinesinpregnancy.org
•    NHS website: www.nhs.uk/medicines/low-dose-aspirin

Your recent blood test has shown that one of the hormones, PAPP- A is lower than expected. This was measured during your combined screening test for Downs / Edwards / Patau syndrome. This is not related to the results of the screening test which will be sent to you in a letter or discussed with you.

What is PAPP-A?

PAPP-A is a hormone that is made by the placenta in pregnancy (your placenta is the organ that provides your baby with the oxygen and nutrients to support them to grow). PAPP-A is needed for the implantation process and to maintain a healthy placenta.

What does Low PAPP-A mean?

Low levels of PAPP-A (when it is less than 0.41 MoM in pregnancy) may be associated with:

• A lower birth weight baby as your placenta may not work effectively.
• An increased chance of having an early birth.
• Miscarriage in the second half of pregnancy.
• An increased chance of developing pre-eclampsia.

Receiving the news that you have low PAPP-A levels may cause anxiety but please be assured that most babies will have normal growth and the pregnancy will progress without problems.

To help reduce the risk of any of these problems occurring, we recommend you commence a treatment of aspirin. A low dose of aspirin will be prescribed for you and should be taken throughout your pregnancy until the birth of your baby. More information can be found in ‘Low-dose aspirin in pregnancy’ information above.

We will also:

• Measure your blood pressure and test your urine for protein at each appointment with your Midwife or Doctor.
• Offer you a uterine artery doppler scan which will be performed between 18-23+6 weeks gestation. More information can be found in ‘Uterine Artery Doppler’ information.
• Offer you additional scans throughout your pregnancy to monitor the wellbeing of your baby.

What can I do to help?

Stop smoking: If you smoke tobacco it is important that you stop as it can affect how well the placenta works and this could affect the growth of your baby. If you would like support to stop smoking, please contact your Midwife who can refer you to the Smokefree Pregnancy Team at Leighton Hospital. Alternatively you can self-refer by visiting the Smokefree Pregnancy Page.

Monitor you baby’s movements: Once your baby starts to move you should be aware of your baby’s normal pattern of movements. If you think the normal pattern has altered, contact Maternity Triage on 01270 273116.

What do I do if I would like more information?
If you would like more information or have any questions, concerns or need further explanation, please discuss this with your Community Midwife or contact the Screening Midwives on 01270 273775.

What is a Uterine Artery Doppler Ultrasound (UtAD) Measurement?

Uterine arteries are the vessels that carry blood to your womb (uterus).

A UtAD measurement is used to check the blood flow of the uterine arteries. The flow of blood within the vessels may give us an indication of whether your baby will continue to grow well and the likelihood of developing pre-eclampsia (a blood pressure condition in pregnancy).

It can be carried out during an ultrasound scan around 18-23+6 weeks. Photographs of your baby will not be available at this appointment.

The doppler measurement uses sound waves to check if the blood is flowing easily (low resistance) or whether it is having to work harder (raised resistance).

Why have I been offered a UtAD?

Your Midwife or Obstetrician has completed an assessment taking into consideration your medical history, previous pregnancy history and factors in your current pregnancy which has shown that you may be at increased risk of having a small or growth restricted baby or developing pre-eclampsia.

It is important that you attend your appointment as this can provide important information to plan your care appropriately during your pregnancy.

What do the results mean?

• A low resistance measurement means that the blood flow to your baby is normal, helping it to continue to grow well. A normal result also indicates that you are less likely to develop pre-eclampsia. You will be then offered growth scans every 3-4 weeks from 32 weeks gestation to monitor your baby’s growth.
• A raised UtAD suggests there is more chance of your baby not growing as well as expected, or an increased risk of you developing pre-eclampsia. It is important to understand that this does not mean that this will happen, only that you are at increased risk. If the measurement shows a raised resistance or positive screen, then you will be offered additional monitoring, scans, hospital appointments and midwife appointments during your pregnancy. That means that if problems do arise, they can be picked up as early as possible.
• Please be aware that it is not always possible to complete the UTAD measurement at the appointment. If this happens, you will be offered ultrasound scans from 28 weeks of pregnancy to monitor your baby’s growth.

Further questions

We hope you have found this information helpful.

If you have any further questions, please speak to your Midwife or Obstetrician, or telephone Antenatal Clinic Midwives on 01270 612171.