Aspirinetta: what and whenSome women are prescribed aspirinette during pregnancy. But what exactly is this drug used for, and when is it taken?
We see it with the help of, an expert in the pathology of pregnancy at the Sacco hospital in our city.
In this article
- Anticoagulant and anti-inflammatory
- when needed
Anticoagulant and anti-inflammatory
The aspirinetta - by the way, the precise name would be cardioaspirin - is a low-dose formulation of acetylsalicylic acid, the active ingredient in aspirin. It has two fundamental effects: anticoagulant, because it inhibits the aggregation of platelets, and anti-inflammatory, because it reduces the levels of some molecules involved in inflammation.
In the context of pregnancy, it has long been used in some categories of women at risk, for prevention of placental pathologies such as preeclampsia, growth retardation, placental abruption, and for reduce the possibility of new abortions in women who have already had it (in these cases we speak of poly-abortion or repeated spontaneous abortions). "In fact, it is believed that clotting problems or factors that drive inflammation are also implicated at the origin of these conditions," she explains. "Hence the idea that an antiplatelet and anti-inflammatory drug can help reduce the risks".
In reality, the use of the aspirinetta in pregnancy is a still hot research topic and in recent years the international scientific community has discussed a lot about the effectiveness of this drug in various situations. The conclusion is that in the face of situations in which the aspirinetta is certainly indicated, there are others in which it is not yet clear if and how much it is really needed. "Unfortunately it is difficult to reach definitive conclusions, because there are many conditions at stake, with similar outcomes that may depend on very different causes", comments the gynecologist.
When the aspirinetta is really needed
Clinical experience and scientific literature clearly state that aspirin is used to reduce the risk of placental disorders - preeclampsia, fetal growth retardation, stillbirth, placental abruption - and abortion in women who have a condition called antiphospholipid antibody syndrome or who, while not having the syndrome, still have these antibodies.
In general, both a critical review by the Cochrane Association and the Guidelines on Hypertension in Pregnancy from Nice, the British National Institute for Health and Clinical Excellence, say aspirin is indicated for all women at high risk of preeclampsia, also for causes other than antiphospholipid antibody syndrome. "These documents emphasize that in these cases the drug significantly reduces the risk of severe preeclampsia, while it is less effective than milder forms, which are less of a concern, "he explains.To be truly effective, aspirin should be taken before 12 weeks of pregnancy, or at least by 16 weeks
For it to really work, however, the aspirinetta must be taken as soon as possible: the ideal is before 12 weeks of pregnancy, and in any case no later than 16 weeks. "This is because the most important stages of the formation of the placenta they occur in the first weeks of the embryo's life, and it is on these that the drug is thought to intervene ", he specifies.
Preclampsia: that's who is at risk
The real problem, however, is figuring out exactly who is at risk for preeclampsia, because there are currently few recognized risk factors. Here are those listed in the Nice Guidelines:
- having had preeclampsia in a previous pregnancy;
- chronic high blood pressure;
- kidney disease;
- some autoimmune diseases such as systemic lupus or antiphospholipid syndrome;
The Guidelines also suggest paying attention to some factors which, taken alone, do not seem to represent a particular risk, but which become worrying if they are present at the same time. For example obesity, twin pregnancy, being over 40, having a family history of preeclampsia. In other words: it is not that all pregnant women over 40 should take aspirinetta, but if they are also obese or are expecting twins, the doctor will most likely prescribe it.
"In practice, what the British Guidelines suggest is to assign a sort of score to each critical factor, and on the basis of the final tally decide whether to administer the drug or not." It is a new way of dealing with risk, very personalized".
The real risk factors for preeclampsia are few: in most cases, this fearful condition manifests itself in the first pregnancy, without anything in the personal or family history of the woman to make it suspect. Precisely for this reason, scientific research is making a great effort to try to identify useful elements for the early diagnosis of the risk of preeclampsia, with the aim of identifying with a simple test the women really at risk of developing the disease among all those in pregnancy. And to do it as soon as possible because, as we have seen, the drugs useful for prevention are only needed if taken before 12-16 weeks.
The main lines of research in this area are two: one concerns the development of protein-based tests of the placenta, which can be measured through a simple blood test. In some hospitals these tests, which for the moment are experimental, are proposed during the bi-test. "But it is important to explain to women that, although they can give an indication, they are not yet completely reliable" explains Valentina, expert in high-risk pregnancies and consultant of the Ciaolapo Onlus association for the protection of pregnancy and perinatal health. "So, if the test signals an increase in risk, don't worry too much: you won't necessarily get sick, but as a precaution the pregnancy will be followed. with some more control".
Another line of research concerns the use of Doppler flowmetry of the uterine and umbilical arteries. It is a particular ultrasound that analyzes the quantity and speed of the blood circulating in these vessels to evaluate the functioning of the placenta. The challenge is to obtain useful information from this exam as early as the first trimester of pregnancy.
Poly-abortion: the aspirinetta does not always solve the problem
For a long time, it has been common practice to prescribe aspirinets automatically to all women who have had it three or more abortions, perhaps without investigating in detail the possible causes of this situation. In reality, it is not certain that in these cases the drug is really useful, and helps to carry on a new pregnancy.
As we have seen, aspirin is effective if repeated abortions are associated with the presence of antiphospholipid antibodies. "However, at the moment there is no evidence that it really is needed in cases where, despite thorough investigations, a possible cause of repeated abortions cannot be identified," he explains, citing the conclusions of another review by the Cochrane association. "Which is not to say that it can't be used in these cases, just that it should not be prescribed on the carpet, automatically".There is no evidence that aspirin is really useful in cases of repeated miscarriages for which no cause has been identified.
"The point is that we are still talking about a drug, which then it can have side effects: for example the risk of allergic reactions, bleeding, placental abruption, fetal haemorrhage if an operative delivery is needed and the aspirinetta has not been stopped in time. Of course, you can also decide to administer it in "doubtful" cases, for which there is not the full support of solid scientific conclusions, but it must be done only after careful evaluation, and never lightly ".
A similar argument applies to recruitment by women who follow assisted fertilization paths. "Also in this case it is sometimes prescribed automatically, assuming that these women have some underlying inflammatory problem, but in reality even in this case a more personalized evaluation should be made" says the gynecologist. "Not all women facing an MAP need it."
Aspirinette in pregnancy: when to stop
You should immediately stop taking aspirin if they occur allergic reactions (such as hives), repeated vaginal bleeding o nosebleed and in case there is previous placenta, that is, a placenta inserted in the lower part of the uterus, to cover the opening of the uterus itself.
In addition, the drug should be discontinued if a surgery, also for reasons other than pregnancy: for example for appendicitis.
Hopefully, the aspirinetta goes anyway suspended a little before childbirth: at least a week before, but to be safe some prefer to stop a few weeks before the expected date for spontaneous or planned birth. 11 PHOTOS
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- termination of pregnancy
- repeated miscarriages
- growth retardation