Podcast Summary

Podcast: Dr. Chapa’s OBGYN Clinical Pearls
Episode: LDA for Unexplained Recurrent SABs?
Date: November 26, 2025
Host: Dr. Chapa
Main Theme: Evidence-based guidance on the use of low-dose aspirin for unexplained recurrent pregnancy loss (RPL), with insights into recent research, practical application, and current national recommendations.

Episode Overview

This episode explores the question: Should low-dose aspirin (LDA) be offered to patients with unexplained recurrent spontaneous abortions (SABs), also known as recurrent pregnancy loss (RPL)? Dr. Chapa reviews the latest research, summarizes current guidelines, and provides practical advice for clinicians evaluating and treating patients with this challenging condition.

Key Discussion Points & Insights

Background on Recurrent Pregnancy Loss

• Prevalence & Impact:
  • “Recurrent pregnancy loss affects about 5% of couples and it's associated with a huge emotional burden.” (00:47, Dr. Chapa)
• Thorough Evaluation is Essential:
  • Diagnosis includes:
    • Antiphospholipid antibody testing
    • Uterine anatomical evaluation (preferably with 3D ultrasound)
    • Parental karyotyping for genetic abnormalities
    • Metabolic panel (diabetes, thyroid function)
  • “Regardless of how you define it, ... they’re devastating... and you should do the appropriate evaluation for it.” (04:09)

Indications for Aspirin in Pregnancy

• Antiphospholipid Antibody Syndrome (APS):
  • Strong indication for LDA + heparin; should begin pre-conception.
  • “Aspirin plus low dose heparin is absolutely the recommendation for... recurrent pregnancy loss in the presence of antiphospholipid antibody syndrome.” (04:09)
• Other Indications:
  • Hypertensive disorders of pregnancy/preeclampsia prevention.
  • “...no other real indication for low dose aspirin in pregnancy.” (04:09)

The Controversy: Aspirin for Unexplained RPL

• Current Guidelines (ACOG, ASRM):
  • Do not recommend LDA for unexplained RPL.
  • The stance is based on large studies (e.g., 2014 RCTs) showing no significant benefit in women without APS.
• Patient Questions:
  • Frequent clinical question: “Is there anything I can do, what about aspirin?”
  • “You can give her aspirin, it’s just not gonna do anything and it’s false hope and it’s not in line with current OBGYN guidance or standards.” (04:09)

Recent Studies & Evidence

• EAGER Trial:
  • Looked at LDA initiated preconceptionally in women with 1-2 prior losses.
  • “Yes, it did say that maybe it could help. However, that study had a lot of limitations.” (04:09)
  • “The majority of the data show no, it doesn't do anything in cases of unexplained recurrent pregnancy loss.” (04:09)
• Latest Meta-Analysis (Pregnancy Journal, Nov 2025):
  • Systematic review included only 3 RCTs, n=656 pregnancies; aspirin dose 50-80mg.
  • “Short answer: There was no significant improvement in continuation of pregnancy with aspirin.” (04:09)
  • Limitations:
    • Small sample
    • Super low aspirin dose (less than a typical baby aspirin)
    • “Maybe 150mg... maybe that could help. But as of right now, further studies... are needed.” (04:09)
• Safety Concerns:
  • “Actually, there's one study that showed it may actually increase spontaneous pregnancy loss outside of antiphospholipid antibody syndrome, but that was one study and it kind of freaked people out.” (04:09)

Practical Clinical Takeaway

• Stick to Guidelines:
  • “To give false hope that recurrent pregnancy loss somehow is going to be better by giving low dose aspirin... It's just not evidence based.” (04:09)
  • “Let's stick right now with national guidance, even though it may change later. But as of right now, there is no benefit outside of antiphospholipid antibody syndrome...” (04:09)
• Manage Patient Expectations:
  • Educate patients and avoid unnecessary interventions.
  • “If you got aps, please use it. If you got some other condition that requires aspirin use, keep using it.” (04:09)

Empathy & Perspective

• Dr. Chapa emphasizes the emotional toll of RPL, encourages clinicians to be supportive and up-to-date, and gives thanks for family and health, especially approaching Thanksgiving.
• “Guys, there’s so many things to be thankful for when you consider the basic necessities.” (04:09)

Notable Quotes & Memorable Moments

• On the impact of recurrent pregnancy loss:

  • “They're an emotional burden. Everyone carries it differently. Some are much more bothered than others, but they shouldn't be ignored.” (04:09)

• On the limits of aspirin for unexplained RPL:

  • “You can give her aspirin, it’s just not gonna do anything and it’s false hope and it’s not in line with current OBGYN guidance or standards.” (04:09)
  • “We've known since 2014 with a large trial that came out and even the Cochrane review showed outside of antiphospholipid antibody syndrome... it just doesn't do anything.” (04:09)

• On research limitations:

  • “This new publication from the journal 'Pregnancy' took a look at three. That's it, three RCTs... with an n of about 656 pregnancies... the dose used was 50 to 80 milligrams. Yo, super low dose.” (04:09)

• On Thanksgiving and gratitude:

  • “I'm very thankful my kids are healthy. I'm thankful, you know, no one's in jail. I can be honest, thankful, you know, we all have our wits about us. You know, we're not suffering with some kind of severe mental illness because, you know, my family had been, has been previously affected by that.” (04:09)

Timeline of Important Segments

• 00:47 - Introduction to recurrent pregnancy loss and aspirin controversy
• 04:09 - In-depth discussion: Evaluation and current recommendations for RPL, summary of landmark studies, and guideline review
• 04:09 onwards - Critique of recent research, discussion of evidence limitations, and final take-home clinical advice

Final Take-Home Points

• Low-dose aspirin (LDA) is recommended only for women with antiphospholipid antibody syndrome, or other established medical indications, not as an intervention for unexplained recurrent pregnancy loss.
• Guidelines from ACOG, ASRM, and SMFM remain unchanged despite ongoing publication and debate; new data don’t currently support LDA for unexplained RPL.
• Clinicians should address the emotional burden, educate patients truthfully, and avoid giving false hope with unsupported interventions.
• Further research is required, especially with higher LDA doses and larger sample sizes.
• Gratitude, perspective, and empathy for the emotional impact of RPL are crucial in patient care.

Host signoff:
“Podcast Family, I think we've done what we're supposed to do... So as always, podcast family, we're thankful for you. Spend time with family and enjoy one another.” (04:09)