Chronic hypertension is a major risk factor for pre-term pre-eclampsia and can strongly increase the risk of developing pre-eclampsia. Your doctor may decide to recommend taking an aspirin treatment for prevention purposes. Appropriate management of blood pressure is also recommended.
There are several reasons why you may be on an aspirin treatment before 12 weeks, with varying doses. Even if you are already taking aspirin at 12 weeks, you should still screen in order to understand your risk for developing pre-eclampsia. Then, based on screening results and your personal history, your physician may decide to maintain or adapt your treatment.
The Aspirin for Evidence-Based Preeclampsia Prevention (ASPRE) trial has shown that aspirin treatment must start before week 16, and ideally the medication should be taken at bedtime (the effect when taking in the evening has proven better than if taken in the morning or afternoon).
Though aspirin is considered safe in drug trials, nonetheless, it is a drug with known side effects, and current safety data are reassuring but still limited. Therefore high-risk women for pre-term pre-eclampsia should be identified before beginning an aspirin regimen.
My risk assessment placed me in the low risk population, even though I already had pre-eclampsia before. Should I take aspirin treatment anyway?
Your doctor should manage you as a low risk case since a detailed review of your biomarkers through screening would indicate that they are normal. However, if your doctor still recommends an aspirin regimen, there is no harm in treating you with it.
After 16 weeks of pregnancy, it is unfortunately too late for aspirin preventive treatment, but you can still be screened to learn your risk for developing pre-eclampsia. Such testing helps your doctor be proactive in cases of high risk so he can closely monitor your health and your baby’s progress to reduce any potential consequences of the disorder.
Noninvasive Prenatal Testing
Traditional screening tests usually provide a “risk score” (such as 1 in 500 or 1 in 50) that describes the chance of a baby developing a certain chromosome problem. These tests can have a relatively high rate of “false negative” (10% to 15% of the pregnancies tested) or “false positive” results (up to 5% of the women tested):
- A false positive case means that a pregnant woman will receive an incorrect positive result indicating she is at high risk; invasive testing may be performed to confirm these results even though the baby doesn’t have any chromosomal abnormalities.
- A false negative test means that a pregnant woman will receive an incorrect negative result indicating she is at low risk, while her baby is actually affected by a genetic condition.
NIPT is known to be more accurate than traditional screening tests as it is associated with a lower number of false positive and false negatives results.
NIPT is a noninvasive procedure which only requires the collection of a blood sample from the mother.In comparison, invasive tests require testing a sample of the placenta (chorionic villus sampling or CVS) or the amniotic fluid (amniocentesis). These invasive tests can accurately determine whether a pregnancy has trisomy 21 (Down syndrome) or other chromosomal conditions. However, the invasive nature of these procedures may pose a risk of complications, including miscarriages.
Clinical validation studies were performed to demonstrate the clinical performance of the Vanadis NIPT solution; these studies demonstrated that it is able to identify more than 990 out of 1,000 Down syndrome cases (greater than 99%). Products used in Vanadis NIPT system have been designed and manufactured according to European IVD directive and are CE marked.
So far, the cost and complexity of existing NIPT technologies have limited the use of the test for women, usually only being used for the “high risk” group. To ensure NIPT can be offered to as many women as possible worldwide, the Vanadis NIPT system was designed to decrease costs of testing in order to increase access to more women. In addition, the system was designed to reduce the number of cases where results are not obtained, also called “test failures” or “no-calls,” to make sure as many women as possible will get an answer when taking this test.
Screening is quick and easy — a simple heel prick is all that’s needed for testing. The tests are performed on dried blood that is collected on filter paper when your baby is two to five days old. Play the video to find out more!
If the screening results are normal — as they are in most cases — no further procedures are needed and parents won’t be contacted. If the screening results indicate the possibility of a rare disorder, the family will be contacted without delay for additional testing and procedures. An abnormal result doesn’t always mean your baby is ill, so a new blood sample will be drawn to confirm the initial test result, and the newborn might be referred for other types of diagnostic testing and/or examination by a specialist.
The diseases we screen for are rare, and the probability of your child actually being affected by one of them is rather small. However, on average, for every day of every year, newborn screening tests allow for early treatment of 70 babies that would otherwise have developed severe diseases. As a result of the newborn screening all of these children get the chance to initiate treatment and have normal healthy childhoods. —
Wright D, Rolnik DL, Poon LCY, Nicolaides KH. Aspirin for Evidence-Based Preeclampsia Prevention trial: effect of aspirin on length of stay in the neonatal intensive care unit.
Rolnik DL, Wright D, Poon LCY, Nicolaides KH. ASPRE trial: performance of screening for preterm pre-eclampsia. Ultrasound Obstet Gynecol. 2017 Oct;50(4):492-495.
Royal College of Obstetricians and Gynaecologists patient information leaflet, Information for you: Pre-eclampsia. RCOG Patient Information Committee, London, UK, Aug 2012.
Roberge et al. (2012) Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: a systematic review and meta-analysis. Fetal Diagn Ther. 2012;31(3):141-6. doi: 10.1159/000336662. Epub 2012 Mar 21.
Bujold et al. (2010) Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol. 2010;116:402-14.
Advise women at high risk of pre-eclampsia to take 75 mg of aspirin daily from 12 weeks until the birth of the baby. NICE clinical guideline 107. Issued: August 2010 last modified: January 2011.
Gil MM, Accurti V, Santacruz B, Plana MN, Nicolaides KH. Analysis of Cell-Free DNA in Maternal Blood in Screening For Aneuploidies: Updated Meta-Analysis. Ultrasound Obstet Gynecol 2017 Sep;50(3):302-314. DOI: 10.1002/uog.17484
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