OpenHealth Q&A

Pregnancy and a Splenic Mass: Navigating Aspirin Use

At 34 years old, currently 12 weeks into my second pregnancy, I find myself in a unique situation. By the time I deliver, I will be 35, categorizing me as an advanced maternal age (AMA) patient. My weight stands at 175 pounds and I am 5 feet 5 inches tall, but so far, I haven’t gained any additional weight this pregnancy. Approximately one and a half years ago, a 3 cm splenic mass was accidentally discovered during a CT scan conducted after my first child was born. Subsequent follow-ups with MRI showed that the mass remained unchanged. It has been classified as indeterminate, likely an atypical hemangioma or a SANT, both of which are benign in nature. However, should a splenic hemangioma grow significantly or become symptomatic, it might necessitate removal of the spleen. Initially, my medical team recommended follow-up MRIs every six months for two years, and suggested I wait for results from two of these scans before pursuing another pregnancy. However, upon confirming my pregnancy, the decision was made to use ultrasound to track the mass instead, as the contrast in MRIs could potentially pose risks to the developing fetus. Unfortunately, the ultrasound did not provide clarity on the mass, and monitoring will be resumed after delivery. Given my status as an AMA patient, my weight, my father’s history of hypertension, and a personal family history of an atypical postpartum pulmonary embolism, my nurse practitioner has advised me to take a daily low-dose aspirin during pregnancy to mitigate the risk of developing pre-eclampsia. This leads me to my primary concern: Is it safe to include baby aspirin in my regimen considering the presence of the splenic mass? I worry that hormones and vascular changes associated with pregnancy could cause the mass to enlarge, possibly leading to a rupture of the spleen. There is a slight risk of hemorrhage, and I’m hesitant about taking a medication that could thin the blood. Additionally, I fear that the mass might rupture during labor or in the postpartum phase. While I aim to limit pre-eclampsia risks through lifestyle modifications rather than medication, I recognize that not all instances of pre-eclampsia are preventable. I maintain an active lifestyle, running 3 to 4 times a week, engaging in light strength training a couple of times weekly, and going on walks with my daughter. My diet is generally healthy, rich in protein, fruits, and vegetables, and I’ve been successfully reducing my sugar intake. In my first pregnancy, I did not encounter any complications, nor have I ever dealt with high blood pressure or elevated blood sugar levels. I’ve understood that once you have a pregnancy without pre-eclampsia, the likelihood of experiencing it in later pregnancies decreases, though I’m aware that isn’t a hard and fast rule. On the other hand, if taking baby aspirin does not sufficiently thin my blood to result in complications in the event of a rupture, perhaps I should consider including it in my routine. My aim, above all, is to ensure a healthy outcome for my baby. I am also taking prenatal vitamins, iron, and fish oil daily, and I’ve wondered about the safety of fish oil in conjunction with blood thinners. I'm seeking insights here, as I’ve found splenic masses similar to mine are relatively uncommon, and many healthcare providers I have consulted seem unfamiliar with managing such conditions during pregnancy. I ponder if consulting another specialist may be beneficial. Unfortunately, online searches haven’t yielded much help. I am open to providing more information if needed and I appreciate any guidance or recommendations you may have! Thank you for your time and assistance!

Answers (1)

3/29/2025, 6:10:49 PM

OpenHealth AI

It's understandable that you're concerned about the use of low-dose aspirin during your pregnancy, especially with a splenic mass present. Let’s break down your situation and explore the safety and management of your concerns.

Main Points:

• Safety of Low-Dose Aspirin: Low-dose aspirin is often recommended in pregnancy to reduce the risk of pre-eclampsia, especially for women of advanced maternal age or with risk factors. There's limited evidence suggesting it causes problems related to benign splenic masses.
• Monitoring Your Health: Given the history of your splenic mass, it's crucial to continue regular monitoring and to weigh the benefits of aspirin against your unique health circumstances.
• Lifestyle and Communication with Care Team: Maintaining a healthy lifestyle is beneficial. You should openly communicate your concerns with your healthcare team, who might consider your entire clinical picture.

Explanation:

Low-dose aspirin is generally considered safe during pregnancy and is prescribed specifically to mitigate risks such as pre-eclampsia, particularly in women who may have increased risk factors. While your concerns about the splenic mass and potential bleeding are valid, studies indicate that low-dose aspirin does not seem to increase the risk of complications such as spleen rupture in patients with benign masses.

That said, every case is unique. The current understanding is that changes in hormones and vascular dynamics during pregnancy can affect all organ systems, but there is no strong evidence that low-dose aspirin would exacerbate your specific situation regarding the splenic mass.

Additionally, managing your risk of pre-eclampsia through medications like aspirin should take precedence, especially since you have other risk factors.

Next Steps:

1. Discuss Aspirin with Your Healthcare Team: Schedule an appointment to discuss the use of low-dose aspirin in your context. Address your concerns about the splenic mass and ask for their specific recommendations.
2. Regular Monitoring: Continue with recommended follow-up ultrasounds to keep an eye on the splenic mass. Ensure your healthcare provider knows how important this is to you.
3. Maintain a Healthy Lifestyle: Keep your current active routine and healthy diet; these habits are beneficial for you and your baby.
4. Consider Consulting a Specialist: If you feel uncertain, seeking an opinion from a maternal-fetal medicine specialist may provide you with more tailored insights regarding the management of both your pregnancy and the splenic mass.
5. Safety of Fish Oil and Blood Thinners: Fish oil is commonly safe to take with low-dose aspirin, but you should confirm this with your care providers to ensure all your supplements are coordinated without risk.

Empower yourself with knowledge and remain proactive in your healthcare decisions. Your health and the well-being of your baby are paramount, and seeking the right support will help you navigate this unique journey. If you have more questions, feel free to reach out!