Response to reader - Recurrent miscarriages and aspirin treatment (Pt 2)

This is Part II of an article, published August 25, addressing a reader's comments regarding her doctor's use of aspirin to prevent her from having a third miscarriage.

Our writer in the previous article stated that her doctor tested for lupus and it is quite likely that he was testing to determine whether she had antiphospholipid syndrome or APS.

If a woman has certain clinical criteria, including three or more miscarriages before 10 weeks (other causes excluded) or if she loses even one normal foetus after 10 weeks of pregnancy and tests positive for lupus anticoagulant or anticardiolipin antibodies, then she is said to have the syndrome.

One of the ways in which APS may lead to pregnancy loss is that it appears to interfere with different factors in the blood that are associated with the clotting system. As a result, blood clots may form inappropriately in the blood vessels of the placenta, affecting its functioning. If she has APS, she should be treated with low-dose aspirin and heparin throughout the pregnancy. Recent research suggests that aspirin alone may be sufficient treatment but, generally, both aspirin and heparin are recommended.

The aspirin miracle

Treatment usually results in about 75 per cent of these women having a child. If a woman has recurrent miscarriages and no cause is found (for example, she tests negative for antiphospholipid antibody syndrome), a recent study suggests that there is no benefit in treating such a woman with aspirin or aspirin and heparin. I suspect that, despite these results, many doctors will still offer treatment to these women to offer hope in this very distressing situation.

Aspirin has other benefits in pregnancy besides the treatment of APS.

A recent review confirmed that if low-dose aspirin is started in women who are at risk for pre-eclampsia (elevated blood pressure and excess urine protein in pregnancy) before 16 weeks of pregnancy, there are a number of benefits. They have a reduced risk of developing pre-eclampsia, severe pre-eclampsia and intrauterine growth restriction (babies who grow slower than the normal rate in the womb) and even preterm birth (birth before 37 weeks of pregnancy). Although any medications may have risk, low-dose aspirin appears to be safe for use in pregnancy.

No magic drug

There is no magic drug to prevent all miscarriages or all complications in pregnancy but aspirin, whether alone or combined with heparin, has proven to help many women if used for the correct indications. I would like to thank our writer for sharing her story and, hopefully, more women will benefit from this treatment.

Dr Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.