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Cardiology

Aspirin during pregnancy: can it be taken?

Effects of aspirin

Acetylsalicylic acid is the active substance of Aspirin and belongs to the class of non-steroidal anti-inflammatory drugs, which is widely used for various diseases (myocardial infarction, coronary heart disease, unstable angina pectoris, a tendency to thrombosis, strokes) due to its ability to prevent clot formation. Also, the drug is used as a symptomatic therapy for pain syndrome of various origins and slowing down the inflammatory response.

Effects of taking Aspirin:

  • Analgesic;
  • Anti-inflammatory;
  • Antipyretic;
  • Antiaggregatory (blood thinning).

The above effects are provided due to the non-reversible inactivation of cyclooxygenase (COX), as a result of which hyperemia, exudation, edema, permeability of the microvasculature decrease and the fibrinolytic activity of plasma increases.

The drug has a number of contraindications (including ulcerative lesions of the gastrointestinal tract) and side effects. Aspirin is prohibited for children under 16 years of age due to the development of severe liver and kidney dysfunction.

The likelihood of complications and side effects is directly proportional to the dose of Aspirin and the duration of its use.

Can ASA be used during pregnancy?

During preclinical trials, it was found that salicylates have a teratogenic effect (pathology of embryonic development with the formation of congenital defects).

The use of high doses of ASA (more than 150 mg / day) during pregnancy, constantly or intermittently, is contraindicated.

Acetylsalicylic acid during pregnancy at a dose of 40-75 mg / day is indicated for patients with:

  • systemic lupus erythematosus;
  • varicose veins of the lower extremities;
  • the risk of gestational arterial hypertension;
  • preclampsia;
  • antiphospholipid syndrome.

Aspirin therapy at a dose of 40-75 mg / day in pregnant women with the above-described conditions, starting from the 12th week of gestation, protected them from premature birth, placental abruption, and intrauterine growth retardation.

ASA blocks the formation of prostaglandins in the body (biologically active substances that affect the contractility of smooth muscles and the reproductive system). The lack of these substances leads to impaired implantation of the ovum, resorption of the yolk sac, anemia, bleeding in the postpartum period, prolonged pregnancy. Due to the lack of prostaglandins, the follicle ruptures and the egg is released into the fallopian tube.

But the use of low doses of Aspirin (75-100 mg / day) during the IVF procedure does not lead to a critical decrease in prostaglandins. On the contrary, the implantation rate was increased due to the improvement of blood flow in the ovaries and uterus.

Also, in pregnant women, the likelihood of developing side effects increases:

  • lengthening of bleeding time;
  • dizziness;
  • noise in ears;
  • hyperventilation;
  • migraine.

Consequences of prenatal effects of high doses of Aspirin:

  • Congenital malformations;
  • An increase in the level of perinatal mortality, mainly due to stillbirth;
  • Delayed intrauterine development of the fetus;
  • Congenital salicylate intoxication;
  • Decreased ability to bind globulins;
  • Violation of the blood coagulation system of newborns;
  • Functional disorders of the vascular system of the lungs.

Aspirin easily crosses the placental barrier. In the last weeks of pregnancy after taking it, the concentration of salicylates is higher in the newborn than in the mother.

The biotransformation of the drug occurs in the liver with the participation of glucuronyl transferase and is excreted from the body through the kidneys. Consequently, the metabolism of the drug is limited by enzyme activity. During pregnancy, the above organs have an increased load associated with cleaning the blood from the waste products of the fetus. The half-life of the drug can increase up to 30 hours, as a result of which the risk of overdose increases.

Consequences of application at different times

The greatest danger is the appointment of Aspirin in the first trimester of pregnancy. Until 12 weeks of gestation, even minimal doses of ASA are prohibited.

Possible consequences:

  1. Development of an ectopic pregnancy;
  2. Detachment of the ovum;
  3. Early spontaneous abortion;
  4. Formation of congenital defects:
    • Facial skull (cleft palate, cleft lip);
    • Neural tube (spina bifida - spina bifida);
    • Heart (atrial septal defect, tetrad of Fallot). Develops with the use of Aspirin from the 5th day of the last menstruation to the 9th week of pregnancy;
    • Violations of the formation of the reproductive and urinary systems (hypospadias in boys);
    • Deformation of the ribs and limbs;
    • Polydactyly;
    • Diaphragmatic hernia;
    • Anophthalmia.

In the second trimester, the use of Aspirin at a dosage of 40-80 mg / day in patients with direct indications has the least effect on the formation of the fetus and the course of pregnancy. But nevertheless, the appointment of drugs with acetylsalicylic acid in the first trimesters of pregnancy is not recommended without a clear clinical need.

The use of Aspirin for the purpose of pain relief or temperature reduction during this period is fraught with:

  1. Delayed fetal development;
  2. Premature detachment of the placenta;
  3. Anemia;

If the pregnant woman still takes the medicine in the first and second trimesters, the dose of the drug should be minimal, and the course of treatment should be reduced as much as possible.

In the third trimester, the use of Aspirin can cause a number of complications:

  1. From the mother's side:
    • Postpartum bleeding;
    • Postponing pregnancy;
    • Prolonged labor, weakness of labor;
    • Complications in childbirth (caesarean section, the imposition of obstetric forceps, vacuum extraction of the fetus);
  2. From the side of the fetus:
    • Premature closure of the ductus arteriosus, pulmonary hypertension;
    • Congenital intoxication with salicylates with kidney damage and the development of failure;
    • Low birth weight;
    • Withdrawal syndrome (agitation, monotonous cry, reflex irritability, hypertonicity);
    • Hemorrhagic complications:
      • Thrombocytopenic purpura;
      • Petechiae;
      • Hematuria;
      • Cephalohematoma;
      • Subconjunctival hemorrhage;
      • Intracranial bleeding

There is also an adverse effect of the full dose of Aspirin (300 mg and above) in the first trimester of pregnancy on the IQ level of children and their ability to learn. Physical development does not suffer at the same time.

The use of ASA in the last weeks of pregnancy is a contraindication to epidural anesthesia due to the high risk of bleeding, intravertebral hematoma and spinal cord compression.

Aspirin passes into breast milk and may cause a decrease in platelet activity in a baby. It is not recommended to use ASA during lactation.

Women during pregnancy planning should not take any drugs from the NSAID group, including Aspirin. Since it blocks the implantation of a fertilized egg in the uterus and increases the risk of spontaneous abortion.

Conclusions

Considering all the above risks, it is strictly forbidden to use Acetylsalicylic acid for pregnant women to eliminate pain of various etiologies or symptomatic treatment of colds.

Acetylsalicylic acid also contains: Askofen, Citramon, Copacil, Pharmadol, Upsarin-Upsa and many other trade names.

But if the gynecologist prescribed the drug in low doses for complicated pregnancy, you should not refuse to use it on your own. In this case, the expected positive effect outweighs the risks.

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