Low PAPP A and Aspirin

[InsideOut91]

Currently 25 weeks with my second baby. First pregnancy was pretty smooth, this one I’ve been told I’ve got Low PAPP A and am taking 150mg aspirin every day.

ive researched and had the info from professionals and im not too worried, I know its about managing risk and monitoring closely.

my main concern is that ive been told to take the aspirin for the entire pregnancy but even the aspirin box itself says its dangerous to take in late pregnancy, and surely it will increase my risk of haemorrhaging with either natural birth or c section?

Anyone take it up to delivery, if not, when did you stop taking it?

With my first pregnancy I took aspirin until my c section at 39 weeks and all was okay. With my second pregnancy I was told to stop at 36 weeks.

I would clarify at your next consultant appointment when you’ve to stop taking it. If they say right until the end then query and ask them to explain why.

I’ve been taking 150 mg of aspirin since 12 weeks. I’m now 32+1 and I’ve been told to continue taking it up until labour

I took aspirin for low PAPP A all the way through pregnancy and even when overdue. Was induced at 41 + 2 and everything was absolutely fine.

I took it until 36 weeks and I have a platelet condition that puts me at increased risk of haemorrhaging (and even then it was fine). I had a c section at 39 weeks.

Thank you for your responses and experiences - I’m definitely going to ask basically everyone I am seen by at this point, but I’m scared of getting bad information because I hear all too often of bad medical advice or things being missed by doctors.

That 150mg is a decreased dose of aspirin. The average dose of aspirin is 300mg. It’s supposed to improve blood flow to ensure baby gets the nutrients to avoid leaving the baby to feed off a placenta that is not working very well. Aspirin on its own wouldn’t make the risk of haemorrhage greater, it would however increase the risk if it would be consumed together with blood thinners which we normally wouldn’t be taking.
The practical function of aspirin, onto the blood is that is slows down or prevents the formation of blood clots.
Towards end of pregnancy we are more at risk of blood clotting, the greatest risk being post partum (hence the injections) so it is actually the opposite of what you worry about. Aspirin can be rather beneficial if taken towards the end.

Read up on that thought, there’s studies about that.

150mg is very very low dose aspirin and is standard for pregnancy conditions like low Papp-A, clotting conditions like APS, which I have, and to prevent pre eclampsia. It’s also prescribed at 150mg to pregnant women over the age of 35, and to expectant mums with a BMI over 35. It’s been used in pregnancy for years and years, across hundreds of hospitals in a lot of countries - all of Europe and the USA at least. That provides a huge amount of data we can take reassurance from for that dose being compatible in pregnancy.

What you can’t do in pregnancy is take it as a painkiller, those doses are much much higher (600mg x 4 doses in 24 hours), just like you can’t use other NSAID painkillers like ibuprofen and naproxen. That’s why it says on the packet not to take it in pregnancy. Taking a measured low dose under the guidance of your medical professionals based on all this data and historic cases is fine.

I take 150mg every day and will do forever.

If low Papp-a is your only risk factor you will probably be advised to stop taking it around 36 weeks.

I had 2 c sections at 37 weeks (opted for that over induction). First one I did as I was told and stopped taking aspirin 10 days before. I lost 400ml of blood which is pretty good. I wasn’t happy about stopping though as obviously the purpose of aspirin is to stop your platelets being sticky, and both APS and pregnancy make your platelets sticky, increasingly as the pregnancy progresses.

Between pregnancies I found out that some hospitals will operate on patients (in general, not just in pregnancy) who take up to 200mg of aspirin daily, so I declined to stop taking it prior to that c section. I lost 400ml again.

I've been told to take it until 37 weeks but like you I'm concerned about a post-partum haemorrhage. Especially because the risk of a pre-term birth is higher with low papp-A so there's a greater than usual risk that I will labour before I hit 37 weeks, and also because I had a (small) post-partum hemorrhage after the birth of my second child. I have never had problems with blood pressure, if anything mine tends on the low side. I'm going to discuss it all with midwife/obstetrician much nearer the time but I'm considering possibly stopping it a little earlier say 34 or 35 weeks if my blood pressure remains fine.

I can't remember if it is NICE or RCOG guidelines but they say specifically that research points to the aspirin being beneficial to reduce the risk of intrauterine growth restriction only when it's started before 16 weeks of pregnancy. The research overall shows no benefit for feral growth when started later than that. It's well accepted that the benefit for the placenta comes in that early second trimester period.

That last part is incorrect. It’s optimal to start before 16 weeks. Optimal. It’s not true that research shows no benefit with regard to IUGR when started after 16 weeks. It’s debatable whether starting aspirin after 16 weeks has any impact on preventing pre eclampsia. I suggest you include a reference in future to make sure your information is accurate.

With my first i took it cos i was originally expecting twins and recommended. we loss one at 10 weeks but continued taking just cos i did. took it til the day she was born at 34 weeks. deff didn't haemorrhage i think i lost like half the average amount of blood lost (about 300ml).

Now 30 weeks with no 2 and they've told me to take from 4 weeks as i'm diabetic. no ones told me when or if i should stop though

Hi all, sorry for the late reply to your responses, I forgot I’d even written this post!
thank you for all your experiences and insight, I think I’m just a big worrier and this is different to my first pregnancy where I didn’t have this issue but the problem with a lot of medical professionals they gloss over things or give you an answer to fob you off when I’m a person who likes the most information I could possibly have.
it seems like the experiences are largely positive without adverse affects so thank you for sharing!

I took it until some point, can't recall exactly when. I think originally it was prescribed until 37 weeks but then I actually stopped taking it earlier (on medical advice) because they wanted baby out by 37 weeks.

But I do remember discussing it with the consultant as we went through a phrase where every scan from about 30 weeks could have been the one where they decided baby hadn't grown enough and needed her out ASAP. And basically he said not to worry about it, it'd be fine!