DAVID GREENE, HOST:
One of the biggest killers of women in childbirth in the United States is something called preeclampsia, a type of high blood pressure in pregnancy. Even when it's not deadly, it can be serious, leading to seizures for the mother or to babies being born prematurely. There is a tiny, inexpensive pill that can cut the risk of preeclampsia. But as NPR's Selena Simmons-Duffin reports, not all women who need it are getting it.
SELENA SIMMONS-DUFFIN, BYLINE: When a woman gets preeclampsia during her pregnancy, her blood vessels constrict. Blood can't flow easily to her kidneys or brain or uterus. That's what's happening inside her body. On the outside...
BRIDGET DESMUKES: My feet were swollen. My hands were swollen.
SIMMONS-DUFFIN: Bridget Desmukes says at the end of her pregnancy eight years ago, something was suddenly very wrong. There was the swelling, and she was incredibly tired. She's a nurse. She knows all about preeclampsia. And she was scared.
DESMUKES: Like, am I going to have a heart attack while I'm going through? You know, am I going to be able to make it through this?
SIMMONS-DUFFIN: She was also aware that, as a black woman, her risk of dying in childbirth is around three times higher than it is for white women.
DESMUKES: You know, we ended up having caesarean section, and they got her out and she was OK. But even through that process, just that fear.
SIMMONS-DUFFIN: That baby who was OK is a big kid now. Her name's Mila. She just turned 8, the middle of five kids.
SIMMONS-DUFFIN: The house is lively and musical.
(SOUNDBITE OF PIANO PLAYING)
SIMMONS-DUFFIN: Desmukes and her husband love having a big family, and now she's pregnant again. Having preeclampsia once means she's at high risk for getting it again. So this time, she's taking low-dose aspirin every day.
(SOUNDBITE OF PILL BOTTLE SHAKING)
SIMMONS-DUFFIN: We're not talking about aspirin for pain relief. Pregnant women are supposed to take Tylenol for things like headaches. These are baby aspirin, just 81 milligrams, what people take every day if they've had a heart attack or stroke.
DESMUKES: And I love the fact that they're itty-bitty.
SIMMONS-DUFFIN: So far, everything's going well. No signs of hypertension. Aspirin works by relaxing blood vessels.
JODI ABBOTT: What it does is lower the blood pressure but also improve blood flow to the baby, to the kidneys and to the brain, lowering the chance that the woman would have any complications to her pregnancy that would affect either her or her baby.
SIMMONS-DUFFIN: That's Jodi Abbott, an OB-GYN at Boston Medical Center who specializes in high-risk pregnancies. She runs the Prenatal Aspirin Project, which does research and advocacy with the goal of getting more women who are at risk of preeclampsia to take low-dose aspirin. Dr. Nyia Noel is her co-director.
NYIA NOEL: This topic is very important to me as a black woman but also as a black obstetrician-gynecologist in the service of women of color every day.
SIMMONS-DUFFIN: Not only are African American women more likely than white women to develop preeclampsia, they're more likely to die from it. Noel tells her patients that low-dose aspirin can reduce the risk of preeclampsia by 24%.
NOEL: It's been shown to be very safe. And things that people worry about, such as bleeding in pregnancy, or something called placental abruption, which is early separation of the placenta, have not shown to be increased in women on low-dose aspirin.
SIMMONS-DUFFIN: It's not just African American women. Lots of women are at risk for preeclampsia. If you're having twins, or if you have a condition like diabetes, for instance, you're considered at high risk, and low-dose aspirin is recommended for you. There are also moderate risk factors, like if you're pregnant with your first baby, you're obese or you're over 35. If you have several of those, aspirin is recommended for you, too. Abbott says, if you add all those things up...
ABBOTT: Eighty-six percent of our patients would be eligible for aspirin based on those criteria. When you look at a number like 86%, you can understand why I would be in favor, as a public health initiative, of all pregnant women getting it.
SIMMONS-DUFFIN: As she sees it, screening for risk factors inevitably means someone who could benefit will get missed. She argues since there aren't significant downsides, all pregnant women should take it.
ABBOTT: And if I would guess ahead to 10 years, my guess is that you'll be able to buy, included in your prenatal vitamin, low-dose aspirin.
SIMMONS-DUFFIN: So coming to a prenatal near you?
ABBOTT: (Laughter) Yes.
SIMMONS-DUFFIN: Not everyone is convinced that a universal approach is a good idea here. Count Dr. Karina Davidson of Northwell Health among them.
KARINA DAVIDSON: I am a member, as a volunteer, of the United States Preventive Services Task Force.
SIMMONS-DUFFIN: This is an influential group. Their current prenatal aspirin recommendations, put out in 2014, do not recommend that women without any risk factors for preeclampsia take low-dose aspirin.
DAVIDSON: When we looked in 2014, we found little evidence that existed that, in average-risk populations, there was benefit.
SIMMONS-DUFFIN: So for average-risk women, the bar is, there has to actually be a benefit?
SIMMONS-DUFFIN: You can't just recommend, take aspirin because - why not?
SIMMONS-DUFFIN: They just began looking to see if new research has come along since 2014 to change their guidance. That review won't be finished for several years. Dr. Jodi Abbott says, in the meantime, the Prenatal Aspirin Project is trying to figure out why more at-risk women aren't taking low-dose aspirin.
ABBOTT: We would have our patients say to us, I got a prescription, but I'm going to Google it before I take it. A lot of references that patients use - including apps, websites, books - say don't take aspirin while you're pregnant.
SIMMONS-DUFFIN: Probably referring to high-dose aspirin for pain relief. Abbott also thinks a lot of doctors, nurses and pharmacists might not be up to date on the low-dose aspirin recommendations.
ABBOTT: A number of commercial pharmacies would put warnings on aspirin, saying, don't take if you're pregnant.
SIMMONS-DUFFIN: The Prenatal Aspirin Project got CVS, Walgreens and Walmart to stop doing that, trying to eliminate that barrier.
ABBOTT: Everybody deserves a healthy baby and a healthy mother, and we're failing at that right now.
SIMMONS-DUFFIN: Of course, Dr. Nyia Noel says, low-dose aspirin isn't the only answer to the country's high rate of maternal mortality.
NOEL: There are certainly other things to be addressed - structural barriers, structural racism involved, and the disparities that exist.
SIMMONS-DUFFIN: This tiny pill isn't going to fix all of that.
NOEL: It's not. But it is something.
SIMMONS-DUFFIN: And, she says, it has great potential to reduce the number of cases of preeclampsia, which kills many women every year.
Selena Simmons-Duffin, NPR News.
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