Hypertensive disorders are one of the leading causes of direct maternal death in Australia (2008-2012). The National Institute for Health and Clinical Excellence (NICE) recommends women at high risk of pre-eclampsia should take aspirin daily. Background risk PET is 5%, those at high risk have risks of 20%. Aspirin can reduce PET by 40-50% if started before 16 weeks. Calcium can reduce PET by 40% if started before 20 weeks.

This document will assist staff in identifying those high-risk women who have one or more high risk factors for developing pre-eclampsia in pregnancy and therefore should be treated with Aspirin and Calcium.

NICE = National Institute for Health and Clinical Excellence.

PIH = Pregnancy induced hypertension.

PET = Pre-eclamptic toxaemia.

PAPP = Pregnancy associated plasma protein.

EFW = Estimated fetal weight.

BMI = Body Mass Index.

High Risk Factors for developing pre-eclampsia (20%) Give aspirin and caltrate in pregnancy to all:

• Hypertensive disease during a previous pregnancy INCLUDING PIH or PET.

• Chronic kidney disease.

• Autoimmune disease such as systemic lupus erythematosis or antiphospholipid syndrome.

• Type 1 or type 2 diabetes.

•  Chronic hypertension.

•  PAPP A 0.4 MoM on first trimester screening.

•   Previous fetal growth restriction, defined by EFW < 10 centile at any gestation.

• BMI >/= 35 at booking.

Moderate risk factors for developing pre-eclampsia Give aspirin/caltrate if two or more moderate risk factors present:

• First pregnancy

•  Age 40 years or older

•  Pregnancy interval of more than 10 years

•  Family history of pre-eclampsia

•   Multiple pregnancy

• ASPIRIN

As per current evidence, the recommended dose is 100mg of aspirin daily at night from confirmation of a viable intra-uterine pregnancy (8-10 weeks) or as early as possible in 2 trimester before 16 weeks, until 36 weeks. Advise to take aspirin with food.

At every visit post 35 weeks, clinicians should check with the patient that they have ceased taking their aspirin.

Contraindications include an allergy to aspirin or NSAIDS and aspirin sensitive asthma. Relative contraindications include: a history of a previous GIT bleed, severe hepatic dysfunction, peptic ulcer disease or nasal polyps.

CALCIUM

Evidence supports 1g daily started before 20 weeks gestation reduces risk of pre eclampsia by 40% (but not IUGR). 2g daily for those with low calcium diets. Continue until birth.