How prenatal aspirin brings health equity

Black women continue to face daunting and staggering health challenges in terms of pregnancy and childbirth. In the US, black women are 243 percent more likely to die from pregnancy-related causes than their white counterparts.  A report from the CDC states that black mothers in the U.S. die at three to four times the rate of white mothers, one of the widest of all racial disparities in women's health. In addition, a national study of five medical complications reported higher pregnancy-related mortality among black women from preeclampsia, eclampsia, abruptio placentae, placenta previa, and postpartum hemorrhage is largely attributable to higher case-fatality rates.  Moreover, a comprehensive joint NPR/ProPublica report explained that for every woman who dies from childbirth, 70 more come close to dying during or after a pregnancy due to Severe Maternal Morbidity (SMM).  Even when factors such as physical health, access to prenatal care, income level, education, and socio-economic status are controlled for, black women are still far more likely to experience maternal mortality than non-Hispanic white women. These alarming statistics are significant, given that Black women represent only 7% of the total U.S. population.

Further complicating matters are the barriers from the current political climate towards immigrant women of color to access reproductive health care.  Many undocumented women are feeling reluctant to access prenatal or preventive health care services, fearing that may lead to governmental action, including detention and deportation. It is noteworthy to mention that prior to coming to the US, a great majority of black immigrant women have had limited or no access gynecological services.  This is especially true for newly arrived—and often poor immigrant women from the Caribbean and certain African countries. Consequently, more restrictive access to reproductive health services could lead to late or no prenatal care and high-risk complications such as high blood pressure and pre-eclampsia. 

RSP recognizes that black women are often the cornerstone of their families and communities. The failure to correctly provide equitable prenatal care and other social determinants of health can result in severe maternal illnesses—or death.  To that end, RSP and the Boston University School of Medicine have initiated a meaningful collaboration which aims to inform women of African descent on the danger of hypertensive disorders during pregnancy – more in particular around the complications of pre-eclampsia and eclampsia.

Below is a post written by Dr. Nyia Noel and her team from the Boston University School of Medicine to disseminate and promote relevant information about the high efficacy and affordability of prenatal aspirin as preventive medication for pre-eclampsia.

How prenatal aspirin brings health equity

Cynthia Wang; 4th year medical student, Boston University School of Medicine

Nyia L. Noel, MD, MPH; Assistant Professor, Obstetrics and Gynecology, Boston University School of Medicine

Jodi Abbott, MD, MSc, MHCM; Associate Professor, Obstetrics and Gynecology, Maternal Fetal Medicine, Boston University School of Medicine

Preeclampsia, a hypertensive condition of pregnancy, is the leading cause of maternal death and preterm births in the United States. While hospitals have developed ways to evaluate and treat preeclampsia, it is still a scary diagnosis for any mother to receive during her pregnancy. Sadly, preeclampsia and its associated complications (preterm birth, growth restriction) disproportionately affect women of color, particularly non-Hispanic black women. In recent years, prominent black women have opened up to share their traumatic birth stories and raise awareness about this health disparity. Beyonce spent weeks on bed rest while her twins were in the neonatal ICU, and Serena Williams suffered from a near-fatal blood clot to the lungs the day after she delivered. Both received emergency C-sections for their babies. Despite their high socioeconomic status and access to excellent medical care, both women still found themselves amongst a population that experiences a higher risk for pregnancy-related mortality in the United States. Data gathered by the CDC for its Pregnancy Mortality Surveillance System found that from 2011 to 2015, black women were three to four times as likely to be at risk of pregnancy-related deaths as white women.

Instagram @beyonce @serenawilliams

Instagram @beyonce @serenawilliams

To help reduce this health disparity, our team at Boston Medical Center has been promoting prenatal aspirin as an effective medication to prevent preeclampsia (www.prenatalaspirin.com). We have significantly reduced our rates of hypertensive complications over the last 2 years as well as preterm induction for black mothers. Guidelines from the US Preventive Services Task Force (2014) and the American College of Obstetricians and Gynecologists (2018) have started recommending daily 81-mg aspirin to pregnant women at high risk for preeclampsia.

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However, not every clinician and future mother knows that aspirin is safe and effective to take during pregnancy. We need your help to share what you know with colleagues, friends, and family! As more high-risk women use aspirin, we hope to see widespread improvement in pregnancy-related racial disparities. Many health equity champions believe that prenatal aspirin will eventually be given to all pregnant women, due to the extreme pregnancy safety value at low cost and without risk (except in women with aspirin allergy). Please read below for more information about preeclampsia and prenatal aspirin:  

What is preeclampsia? It is also known as hypertension of pregnancy, or gestational hypertension. In severe cases, patients may develop injuries to their kidneys, liver, eyes, and/or brain. Eclampsia is the most extreme form, characterized by seizure(s) that occur during or shortly after delivery.

What are the symptoms of preeclampsia? You could have a headache, swelling in the hands and feet, or abdominal pain.  You might also feel completely normal, so it’s important to go to all your prenatal appointments and have your blood pressure checked!

I’ve never had high blood pressure, can I still get preeclampsia? Yes! Our bodies go through many changes during pregnancy, and many women who develop high blood pressure during pregnancy had normal values before their pregnancy. It is important to make any lifestyle changes or take medications as recommended by your provider during pregnancy.

What are the risk factors for preeclampsia? Patients are at risk for preeclampsia if…

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How long and how often do I have to take prenatal aspirin? Patients should take 81-mg prenatal aspirin starting at 12 weeks of pregnancy (or start as soon as possible if prescribed later) up until delivery. Data have shown that aspirin best prevents high blood pressure during pregnancy when taken at night.

How does prenatal aspirin work? And is it safe? Prenatal aspirin works by decreasing the hormones that constrict blood vessels in the mother and the placenta (an organ attached to the inside of the womb and facilitates sharing of blood during pregnancy). Over 30 years of research has shown that taking prenatal aspirin is safe for mothers and babies.

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How can I help? By talking to your families, friends and colleagues about the benefit of prenatal aspirin in reducing the risk of harm from high blood pressure in pregnancy!

For more information and resources, go to www.prenatalaspirin.com

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Dr. Nyia L. Noel is an Obstetrics / Gynecology Specialist in Boston, Massachusetts. She graduated with honors from University of Michigan Medical School in 2010. Having more than 9 years of diverse experiences, especially in obstetrics/gynecology, Dr. Noel affiliates with Boston Medical Center, cooperates with many other doctors and specialists in many medical groups including Boston University Obstetrics and Gynecology Foundation Inc, Internal Medical Associates-ebnhc.

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