Managing High Uterine Artery Resistance in Early Pregnancy: Alternatives to Aspirin

Screening for Preeclampsia

I would like to consult a doctor regarding early pregnancy testing of uterine artery blood flow resistance.
At that time, the doctor found that the resistance was higher than normal and recommended a blood test.
The report indicated that I belong to a high-risk group.
The doctor prescribed aspirin, one tablet daily, but I am allergic to aspirin and cannot take it.
I would like to ask the doctor if there are alternative methods to avoid this or what aspects I should pay attention to.
During my recent prenatal check-up, my blood pressure and urine tests were normal, and there is no family history of hypertension; however, my grandmother has diabetes.
Given this situation, what would the doctor recommend?

Xiao Guo, 20~29 year old female. Ask Date: 2017/03/29

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Preeclampsia screening has an incidence rate of approximately 2-8% and is one of the top three causes of maternal mortality in Taiwan.
Early screening for preeclampsia can be conducted during the first trimester (11-13 weeks of gestation), with a detection rate exceeding 95%.
In addition to recording the mother's family and clinical history, blood tests can be performed to check for placental growth factor (PlGF) and pregnancy-associated plasma protein A (PAPP-A).
Ultrasound can be used to measure the uterine artery pulsatility index (Uterine PI) and the mean arterial pressure (MAP) in both arms, which can help identify mothers at high risk for preeclampsia.
The World Health Organization and the National Institute for Health and Care Excellence (NICE) recommend that pregnant women at risk for preeclampsia take low-dose aspirin between 12 and 35 weeks of gestation, as it can effectively reduce the incidence of preeclampsia and mitigate its adverse effects on both the mother and fetus.
According to recent research, treatment for pregnant women at risk for preeclampsia before 16 weeks of gestation can significantly reduce the risk of developing preeclampsia by 80% and decrease the risk of fetal mortality due to preeclampsia by 60%.
Treatment after 16 weeks is less effective.
Therefore, early screening during pregnancy allows high-risk individuals to receive timely treatment, effectively preventing and reducing the potential harm of preeclampsia to both mothers and babies.
Low-dose aspirin (LDA) is considered effective in preventing the occurrence of preeclampsia in high-risk pregnancies; however, there is currently no unified report on its efficacy and safety.
Low-dose aspirin is more effective in reducing the incidence of preeclampsia or intrauterine growth restriction when used before 16 weeks of gestation compared to after.
While low-dose aspirin may increase the incidence of placental abruption, it does not lead to other major complications.
Strong evidence indicates that low-dose aspirin can effectively prevent preeclampsia, preterm birth, and intrauterine growth restriction in high-risk pregnant women, with no reports indicating safety risks for mothers and fetuses.
For more information, please refer to the Taoyuan Hospital, Ministry of Health and Welfare website: Quality Team / Medical Departments / Obstetrics and Gynecology / Health Education Information / Preeclampsia Screening.

Reply Date: 2017/03/29

More Info

Managing high uterine artery resistance in early pregnancy is a significant concern, particularly when it comes to preventing conditions such as preeclampsia. Preeclampsia is a serious pregnancy complication characterized by high blood pressure and signs of damage to other organ systems, often the liver and kidneys. It typically occurs after the 20th week of pregnancy, but risk factors can be identified early on.

In your case, where high uterine artery resistance has been detected and you are unable to take aspirin due to an allergy, there are several alternative strategies and considerations to manage your situation effectively.

Alternatives to Aspirin
1. Calcium Supplementation: Some studies suggest that calcium supplementation during pregnancy may help reduce the risk of preeclampsia, especially in women with low dietary calcium intake. The recommended dosage is typically around 1,000 mg per day, but this should be discussed with your healthcare provider.

2. Lifestyle Modifications: Maintaining a healthy lifestyle is crucial. This includes:
- Diet: A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support overall health. Reducing salt intake may help manage blood pressure.

- Exercise: Regular, moderate exercise can improve circulation and overall cardiovascular health. However, always consult your doctor before starting any new exercise regimen during pregnancy.

- Weight Management: If you are overweight, losing even a small amount of weight before conception or early in pregnancy can reduce the risk of complications.

3. Monitoring and Regular Check-ups: Since your blood pressure and urine tests are normal, continue regular prenatal visits to monitor your health and the baby's development. Your healthcare provider may recommend more frequent monitoring of blood pressure and urine protein levels as a precaution.

4. Medications: If aspirin is contraindicated, your doctor may consider other medications that can help manage blood pressure or improve blood flow. However, any medication should be prescribed and monitored by your healthcare provider.

5. Consideration of Other Supplements: Some studies have indicated that certain supplements, such as omega-3 fatty acids, may have a beneficial effect on pregnancy outcomes. Again, this should be discussed with your healthcare provider.

Important Considerations
- Family History: While you mentioned that there is no family history of hypertension, your grandmother's diabetes could be a relevant factor. Diabetes can increase the risk of various complications during pregnancy, including preeclampsia. It’s essential to monitor your blood sugar levels and maintain a healthy diet.

- Awareness of Symptoms: Be vigilant for any signs of preeclampsia, such as severe headaches, visual disturbances, sudden swelling of hands or feet, or abdominal pain. If you experience any of these symptoms, seek medical attention immediately.

- Consultation with Specialists: If you are at high risk, consider consulting a maternal-fetal medicine specialist. They can provide more tailored care and monitoring strategies for high-risk pregnancies.

In summary, while aspirin is a common preventive measure against preeclampsia, there are several alternatives and lifestyle modifications that can be beneficial. It is crucial to maintain open communication with your healthcare provider to develop a personalized plan that considers your specific health needs and pregnancy risk factors. Regular monitoring and proactive management can significantly improve outcomes for both you and your baby.

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