Breanna Reeves |
“I am a preeclampsia survivor. My son was in the neonatal intensive care unit,” shared Dr. Amanda P. Williams, clinical innovation advisor at the California Maternal Quality Care Collaborative (CMQCC).
Preeclampsia is a condition that typically begins after 20 weeks of pregnancy. The condition is characterized by high blood pressure and protein found in the urine. Preeclampsia can result in serious or fatal outcomes for both the birthing person and the baby, such as preterm birth or low birth weight.
More than a decade ago, Dr. Williams had preeclampsia while giving birth to her son, an experience that fuels her work today as an obstetrician/gynecologist, medical director and maternal health advocate.
“This is not just my work. This is also my story. We didn’t have this research when my son was born, and so it is personally very important to me as a Black woman, as a Black mother to get this word out in the community,” Dr. Williams said.
In an effort to prevent preeclampsia and address communities that have a high risk of developing preeclampsia, Riverside University Health System (RUHS) – Medical Center joined a state-wide pilot program, led by the CMQCC and sponsored by the March of Dimes, to promote the use of low-dose aspirin (sometimes referred to as “baby aspirin”) as a way to prevent preeclampsia. The program will run throughout 2023.
RUHS pilot program
RUHS was chosen to take part in the pilot program because of their previous joint partnerships with the CMQCC on other initiatives and “because of the high rate of poverty and the high rate of comorbidities that we have in our patients,” according to Dr. Bryan Oshiro, chief of Maternal-Fetal Medicine at RUHS.
Dr. Oshiro explained that while a majority of patients treated across RUHS identify as Hispanic, preeclampsia disproportionately impacts Black patients, who account for roughly 5% of the population in Riverside County.
“In our practice, we find that we don’t treat everybody equally because the risk is not equal,” Dr. Oshiro said. “And so we actually spend more time explaining [preeclampsia] to African American women and making sure that they have even closer scrutiny and follow up and so forth.”
Any pregnant person is at risk of developing preeclampsia, however, research from the U.S. Preventive Services Task Force reported that Black women are at a greater risk for developing preeclampsia than other women and experience higher rates of maternal and infant morbidity.
Particular people who are at high risk of developing preeclampsia include those who already have high blood pressure (hypertension); have family history of preeclampsia; are pregnant for the first time; had previously had preeclampsia; are older than 35 years of age; have high blood pressure, diabetes or an autoimmune disease; and are pregnant with multiple babies.
According to the 2021 recommendation statement by the task force, preeclampsia impacts roughly 4% of all pregnancies in the U.S., accounts for 6% of preterm births and contributes to maternal and infant mortality.
Low-dose aspirin as prevention
Under the pilot program, doctors will recommend the use of low-dose aspirin at 14 weeks gestation, but Dr. Oshiro explained that the conversation regarding preeclampsia and low dose aspirin should be addressed early on in the pregnancy.
“I will say it’s very encouraging that many are seeing that aspirin has great benefits of helping to prevent preeclampsia,” said Dr. Jasmaine Coleman, an Obstetrician and Maternal Fetal Medicine Fellow.
Dr. Coleman explained that the use of low-dose aspirin for patients at risk for preeclampsia is protocol at Arrowhead Regional Medical Center and the NAEBOR medical clinic where she works.
“The thing about aspirin is that [it’s] one of the only things in terms of prevention, at this point, that is more accepted to be able to prevent preeclampsia. So, that is probably one of the only tools we have in terms of preventing preeclampsia,” Dr. Coleman explained.
If low-dose aspirin is not administered or recommended to prevent preeclampsia, patients are monitored for symptoms and signs through lab work to ensure that they are not developing preeclampsia.
One key aspect of the pilot program is to work with and within the community to educate them on preeclampsia and prevention through aspirin. Dr. Oshiro said that the pilot program will allow the Riverside health system to establish a standard of care and develop a model for administering low-dose aspirin as a preventative measure that can work in the community.
“So by doing that, we hope to decrease the incidence of preterm birth, decrease the incidence of small babies and maternal morbidity and death,” Dr. Oshiro stated. He explained that it will be important to promote the use of low-dose aspirin beyond physicians because a lot of patients are not familiar with preeclampsia.
Gaps in research
The recommendation issued by the task force concluded “with moderate certainty that there is a substantial net benefit of daily low-dose aspirin use to reduce the risk for preeclampsia, preterm birth…in pregnant persons at high risk for preeclampsia.”
The guidance is based on the research of 18 randomized clinical trials that examined maternal and perinatal health outcomes and 16 randomized clinical trials to assess the prevention of preeclampsia. The participants in the trial were mostly White individuals, with three trials that included a majority of Black participants.
While the trials demonstrated that the use of low-dose aspirin was beneficial, the recommendation noted research gaps and recognized that “Further research is needed in populations that have the highest rates of preeclampsia, including Black persons. Future trials should recruit adequate numbers of persons from varying racial and ethnic populations, such as Black persons, to have sufficient power to determine the effectiveness of different aspirin dosages…”
“Of course, the long term goals are to prevent preeclampsia. But what this pilot is really focused on is the work with the community, making sure we’re talking to people in the community, developing messages that resonate [and] partnering with other organizations to help get the word out,” Dr. Williams stated.