Low-Dose Aspirin
Depending on your risk factors, your provider may recommend taking low-dose aspirin daily to reduce your risk of developing preeclampsia.
The American College of Obstetricians and Gynecologists (ACOG) and the United States Preventive Services Taskforce (USPSTF) recommend low-dose aspirin for everyone with any one of these high risk factors:
- Previous pregnancy with preeclampsia, especially early onset and with an adverse outcome
- Type 1 or 2 diabetes mellitus
- Chronic hypertension
- Multifetal gestation
- Kidney disease.
- Autoimmune disease with potential vascular complications (antiphospholipid syndrome, systemic lupus erythematosus).
And two or more of the following moderate risk factors:
- Nulliparity (first pregnancy)
- Body Mass Index >30 kg/m2
- Family history of preeclampsia in mother or sister
- Age ≥35 years
- Sociodemographic characteristics (Black persons, lower income level [recognizing that these are not biological factors])
- Personal risk factors (eg, previous pregnancy with low birth weight or small for gestational age infant, previous adverse pregnancy outcome [eg, stillbirth], interval >10 years between pregnancies)
- IVF pregnancy
Timing and Dosing of low-dose aspirin
The American College of Obstetricians and Gynecologists (ACOG) and the United States Preventive Services Taskforce (USPSTF) recommend initiating daily low-dose aspirin between 12 and 16 weeks.
There is no consensus regarding the optimal dose of aspirin for preeclampsia prevention. In the United States, 81mg is typically recommended though some authorities have advocated a higher dose of aspirin (100 to 150 mg) daily, which is also reasonable. Because dosing between 100 to 150 mg requires cutting tablets or alternating doses, 162 mg dose (two 81 mg tablets) is one of the pragmatic options suggested by the Society of Obstetricians and Gynaecologists of Canada and others.
Calcium Supplementation
There is mixed data on the use of calcium supplementation for reducing the risk of blood pressure disorders of pregnancy. The benefit appears to observed mostly in those with low dietary calcium intake who are at high risk of developing preeclampsia based on risk factors.
In the United States, the recommended daily allowance (RDA) for elemental calcium is 1000 mg/day in pregnant, lactating, or nonpregnant women 19 to 50 years old. The United States female population in the reproductive age range has an average calcium intake of 950 mg/day; thus, most pregnant people are candidates for modest supplementation, which may be supplied by a prenatal vitamin.
However, in people who have low dairy intake 1500 to 2000 mg elemental calcium supplementation per day for pregnant people may reduce the risk of preeclampsia, particularly among those at higher risk of developing hypertension.
- Mindfulness
- Self Care
- Exercise
- Vitamin C,D,E supplementation
- Fish Oil Supplements
- Folic Acid
While there are other benefits to these supplements, there is little supportive evidence for their effectiveness in preventing preeclampsia.
Source
Phyllis August, MD, MPHArun Jeyabalan, MD, MSCR “Preeclampsia: Prevention” UptoDate Literature review through: Jan 2022
Traylor CS, Johnson JD, Kimmel MC, Manuck TA. Effects of psychological stress on adverse pregnancy outcomes and nonpharmacologic approaches for reduction: an expert review. Am J Obstet Gynecol MFM. 2020 Nov;2(4):100229. doi: 10.1016/j.ajogmf.2020.100229. Epub 2020 Sep 24. PMID: 32995736; PMCID: PMC7513755.
- FYI 2.5 g of calcium carbonate or 4.75 g of calcium citrate contains approximately 1000 mg of elemental calcium.
Weight Loss
For people with a history of preeclampsia there is some evidence that weight loss, even for those in the “normal” BMI range, may decrease the risk of preeclampsia in a subsequent pregnancy. Of note, studies have shown dieting to be an ineffective approach to weight loss. Here at Sterling Parents we believe that wellness should be the goal, not a number on the scale. When we prioritize our overall wellness by sleeping, eating well, and exercising, weight loss can sometimes be a byproduct. There are a number of downsides to focusing purely on the numbers including disordered eating, feelings of shame, and increased stress and this has a significant impact on our overall wellness.
Stress Reduction
While interventions to reduce stress have not been specifically studied as an intervention for preeclampsia prevention, studies clearly demonstrate an association between increased levels of stress (both self-reported and as indicated by elevated biochemical markers of stress) and an increased risk of preeclampsia. We also see clear evidence in the literature that stress reduction techniques such as mindfulness and time spent in nature lower blood pressure in non-pregnant individuals.
Evidence-based stress reduction:
- Mindfulness
- Self Care
- Exercise
- Vitamin C,D,E supplementation
- Fish Oil Supplements
- Folic Acid
While there are other benefits to these supplements, there is little supportive evidence for their effectiveness in preventing preeclampsia.
Source
Phyllis August, MD, MPHArun Jeyabalan, MD, MSCR “Preeclampsia: Prevention” UptoDate Literature review through: Jan 2022
Traylor CS, Johnson JD, Kimmel MC, Manuck TA. Effects of psychological stress on adverse pregnancy outcomes and nonpharmacologic approaches for reduction: an expert review. Am J Obstet Gynecol MFM. 2020 Nov;2(4):100229. doi: 10.1016/j.ajogmf.2020.100229. Epub 2020 Sep 24. PMID: 32995736; PMCID: PMC7513755.