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May 30, 2024 26 mins
Dr. Amanda Williams, an OBGYN and part of the California Maternal Quality Care Collaborative, discusses the Low Dose Aspirin Campaign funded by March of Dimes. The campaign aims to prevent preterm birth and preeclampsia, particularly in black birthing people. Low dose aspirin improves blood flow through the placenta and should ideally be started around 12 weeks of pregnancy. The campaign focuses on community outreach and education to ensure that patients and providers are aware of the benefits of low-dose aspirin. The conversation also highlights the importance of trust-building and communication between healthcare providers and patients.

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(00:00):
All right, well, welcome toMe Eternal. I am Kenya Gibson here
with doctor Elizabeth chirou CEO of Marchof Dimes and my co hosts right on
a lot of these podcasts that we'vebeen doing, and we're joined today with
doctor Amanda Williams. Welcome to theMaternal Podcast. Thanks so much for having
us. Yeah, super excited tohave you both here today. I know

(00:22):
we are well within the low DoseAspirin campaign, which I know we're going
to talk a lot about today.But a doctor Amanda Williams, why don't
you just tell us about your backgroundand how you've been involved with March of
Dimes. Sure, so, Iam an obgyn by training and I am
based now at the California Maternal QualityCare Collaborative, which is a mouthful,

(00:45):
but we are the California State PerinatalQuality Improvement and we're based at Stanford in
partnership with the California Department of PublicHealth, and one of our big projects
is the Load Aspiring campaign, whichis funded by the March of Dimes.
So it is very exciting to pilotand get some of this work done in

(01:08):
California and then with March of Dimes. We can scale across the country.
That's amazing, and I know,like we a lot of what's coming out
of the low dose Aspiring campaign isa lot of proclemsia prevention and things that
mothers can do to just kind ofstay ahead of the curve. No one
would have thought that low dose aspirinwould have been a solve, like maybe

(01:30):
even five years or so ago.So can you tell us a little bit
about some of the research that's justbeen in the marketplace, and like why
now it's a really good idea forwomen who are expecting to implement this.
So we've been working on this sincetwenty eleven when the Prematurity Research Center started
at Stanford, which is March ofDimes based, and we started with the

(01:53):
bench research that in the lab,the test tubes, the whole nine.
Then we realized this simple thing thatyou can get at your local pharmacy over
the counter can actually prevent pre termbirth, prevent preeclamsia, both of which
are disproportionately impacting black birthing people.So this is an incredible discovery and now

(02:15):
we got to get it out tothe folks. We got to get it
to people. Even when I waspregnant with my son twenty years ago.
It didn't exist. I would havebeen on lodos aspirin and maybe I wouldn't
have gotten preeclamsia, maybe he wouldn'thave gone to the niic you. Maybe
I wouldn't have had postpartum depression ifI had had lodos aspirin. So this

(02:37):
is personal, this is professional.This is such an important piece of information
we need to get into communities thatso many patients are eligible for lodos aspirin
to prevent preeclamsia and pre term birth. That's amazing and it's a very low
cost, right efficient way too toyou know, create a preventive preventative measure

(03:00):
as well, Doctor Chirou. Fromthe perspective of March of Dimes, I
mean, like, how important ofa campaign is this for you all?
Well, first listen, you canhear the enthusiasm from Amanda when I came
on to March Dimes in January.I got very excited about launching this because

(03:23):
it takes something that is low rightthat we knew could have such effects of
reducing preeclamsy, reducing that pre termbirth, and really talking about at that
placenta level that you know, howdo we then implement this broader. So
we started on this about a yearago, learnings from California, really looking

(03:43):
at you know, how impacted familiesare by this. One in twenty five
pregnancies is impacted by a hypertensive diagnosis. When you think about one in five
families have never heard of pre eclampsia. But right with those numbers rising and
then with those outcomes, right thecrisis we're in, and then specifically for
black and brown people, we knowthat they too. It's like one in

(04:04):
four black families has never heard ofbreak lips. That we knew that this
is where we needed to focus.We were so excited to I think that's
when you and I met, Actually, Amanda was last year and about on
one of these conversations about implementation scienceand really about how this was coming out
of really some work that we werealready partnering on. How do we scale

(04:26):
it and make it so that familiescan get the information they need, professionals
can get the information they need,and how can we galvanize around and it's
now called low dose, Big benefits, And so we're excited right to really
get this launched and out to everyone, so and create client sty Awareness month.
We always think that this is thebest time to kind of really amplify.

(04:46):
But that's that's how we started andhow it kind of got launched.
One and I saw one of yourambassadors is Alison Felix, Right, she
did an amazing piece for you alljust about her story and how she was
affected by proclin So what has itbeen like working with her as an ambassador
for the campaign? Well, Ihad a little fangirling, Right, how
can you not you meet her inperson? I met her when she was,

(05:10):
you know, in the middle ofher third trimester and looking stunning,
and also just you know, I'vegot two kids for a track runners,
so I had her sign my shoesand not you know, at least I
brought them with me. I wasa little more embarrassed to ask, but
also just listening and talking to herabout how she really was unaware of preeclamcy
with her first pregnancy, and thento see her taking aspirin right the low

(05:31):
dos asteris throughout her second pregnancy,and then being able to explain, you
know, we really want to getthis out and amplify. I think it
was a natural fit for her andreally excited that she I actually got to
see her at the Society of MFMconference where you know, she was being
honored. I mean, how canyou not, like I said, fangirl,
And then to watch her have setersuccess and we're starting to see a

(05:53):
lot of science and a lot ofthings changing on preade claim stand. So
it's exciting to see and so tohave such an eloquent speaker, someone who
has been so impacted personally professionally,right as Tory Bowen like her own teammates.
Right, So all of it wrappingaround, we're just so glad that
she continues to partner with the MarchDimes and is a and has such a

(06:14):
great outcome. Right, she justdelivered a few weeks ago and with a
full term infant feedback, right witha doula, Like she's the package.
Right. All we want to seeis a success, yeah, and an
interesting perspective, right, coming fromsomeone who's an athlete, right, and
probably health and wellness are a partof her daily life, right. And
to know that you know, there'sno disparities right when it comes to you

(06:38):
know, you living socioeconomically on oneside of the fence versus the other in
terms of access right and what thatlooks like, especially when it comes to
campaigns like this that are giving outsuch vital information for women of color.
So just going back to doctor Williams, I mean, I know you've been
doing a lot of work in thisspace, like what exactly happens to the
body when a woman is pregnant intaking a lodos aspirin. So the key

(07:03):
is the placenta. So the placentais the interface between the baby and the
mom, and what's happening with thelotos aspirin is that it's improving the blood
flow through the placenta in the simplestof terms. And we want to start
early. So ideally you want peopleto start around twelve weeks of pregnancy,

(07:26):
around the end of their first trimester. And so we've got to screen people
early. So that means we needto be asking questions at the first or
second pre natal appointment, and itshould be everyone. So this isn't just
for super high risk people. Thisis for people who are overall low risk

(07:46):
but might be at slight increased riskfor developing pre eclampsia. So that's why
this campaign needs to go to patients, it also needs to go to providers.
It needs to be out in community, It needs to be with the
pharmacists, it needs to be withthe duelas it needs to be with the
community members. And that's one ofthe things that we've been doing in California
is really having this be a multifaceted, outpatient focused, so community focused campaign.

(08:16):
That's very interesting it is that ifthe community is super important, I
would add midwives to your list,right, yes, yes, absolutely,
no, right, I always liketo make sure we amplify every like our
family practitioners. It's really the providers. And I just did a you know,
a grand rounds for internal medicine becausethey said is as safe actually in

(08:37):
pregnancy and I was like, ohmy gosh, ludos aspron is completely safe,
Like please, The one thing youcan do is recommend right and your
pregnancy to talk to your provider.And that's what this campaign is really about,
is go ask your provider, buteven getting that word out to have
that conversation, because patients are havingconversations with others, their midwife, their
family practitioner, their interness. Sojust like to amplify all of that the

(09:01):
place absolutely and it's there's so muchabout trust building and that is something that
we have to overcome. There isso much well earned distrust in black and
brown communities when it comes to medicationsand medicine. And even though it's just
over the counter, get it anywherelodos aspirin. When you're asking a pregnant

(09:24):
person to take something every day forthe rest of their pregnancy, that's a
big deal. And because it isrelatively new, their mom, their auntie,
they're trusted, people might not knowabout this. So we've got to
get the word out and we're empoweringpatients. You know, there's so much
about the black maternal health crisis inparticular that's out there that I get patients

(09:46):
who'll feel scared. I'm like,oh, this is terrible. I don't
want you going into your pregnancy feelingscared. But it's also real. So
let's put that on its head andsay, Okay, what are the things
that you can do to ensure thebest possible outcome and lo doos aspirin is
one of those things. So let'sI want to put it in the hands
of the patients in addition to theproviders and say, hey, if your

(10:09):
provider forgets or if your provider doesn'tbring this up, you bring it up.
This is something that you can doto make sure you are getting the
best care possible. Yeah, Iwould say it's important to bring it up
before you maybe even having symptoms,right, because I think I think sometimes
you wait till we're symptomatic, right, and we were like, hello,
there's a problem right where these areconversations that should be happening beforehand. And

(10:31):
I know, doctor Scherro, youand I have talked about the symptoms of
proclamsia before, but I just kindof want to remind our audience, like
some of the signs that you mightbe, you know, experiencing for clemsia
And at what point in the conversation, right, should the low dose aspin
conversation come up? Well, letme answer that one first before I get

(10:52):
in signs and symptoms, because aman and I can probably both talk about
signs symptoms for a long time.But you should be asking, you know,
before you conceive. Really, butwhat once you're you know, how
are going in to see your providerfor the first time that conversation and you
should be screened to that visit andthen when you start it really at the
end of your first semester, you'retaking it. It's a daily thing throughout
the pregnancy, and that really canaffect right, the onset of preclampsia.

(11:16):
It can ontot you know, thesequalite of that. So the consequences meaning
baby right, so that low birthway to that preterm birth, and that's
really what we're trying to affect.So we are asking patients to ask immediately
and if you start it and evenby your you know, into the second
trimester, there's still benefits. Soit's not like you only have this short

(11:37):
little window to get started. Sothat's the first thing I want to make
sure I say. And then yeah, preclamsy is right a condition. It's
really based on hypertension to disorder thatcan lead to really you know, bad
sequality, So bad consequences in thesense of if it gets out of control
where other organ systems are involved.And most people will have signs or symptoms,

(12:01):
some you know in sort of slowand insidious and others it's a quick
onset, but things like swelling,visual changes. I always talk about what
I call the skotomta or which Ican barely pronounce, but that big vision
change with a big dark hole inthe mineral vision, but sometimes it's a
little more subtle and you usually feelunwell. Screening can be done in the

(12:22):
office right to but blood testing isusually done and then oftentimes it's leading to
a delivery because that is really thetreatment. Right now. We are just
now coming out with some new testingwhich is exciting that's been FDA approved,
which we're excited to see some ofthat, but that's really once you're in
the hospital with the pre aplansia.So we want people to ask about the

(12:45):
symptoms ahead of time, looking attheir weight gain, looking at their swelling,
which you know, swelling is verynormal in pregnancy, but there's abnormal
swilling. Lodge of vomiting is anotherone that lots of women have in the
beginning, but if you have itout of the blue, it's you know,
and it's right up a quadrant pain. You need to bring these signs
of symptoms off and should be reviewingwith your provider specifically any of those signs

(13:07):
or symptoms, and you can goto our March Times dot org to the
website and actually we have tons ofinformation on timeca there as well, and
headache too. Headache is a reallybig one. And when you're listening to
doctor Schiro speak, one of thethings that comes up is these are such
normal pregnancy things and there are amillion reasons a pregnant person can get a

(13:28):
headache. You can be tired,you can be dehydrated, especially in postpartum
you're definitely tired and dehydrated and offkilter. You can get an upset stomach
from lots of different things. Youcan get swollen feet from being on your
feet all day. So the keyis to see is this something that persists?
Does it stay around these symptoms andlet's just get it checked out.

(13:52):
Let's just talk to the doctor ormidwife and get eyeballs on it and listen.
Yeah, and trust is a bigissue, right, It's trusting to
be able to bring this up andnot feel right. It's it's trust.
It's having that environment to be ableto elevate all of those times is this

(14:13):
not okay? Or is this okay? And having a real honest conversation,
I many people in it. You'veprobably have had this too, MANA Right,
So if I had only brought itup sooner, right and sort of
that right away, or you know, and So it's funny you mentioned the
headache that I completely that's exactly right, because that's something we see all the
time, and there's some of thesethings that are so subtle you've got to

(14:33):
ask and you've got to step forwardto be able to bring them up and
have that environment to do so.Yeah, So I'm just thinking back to,
like my first pregnancy. What aboutexcessive weight gain? Right, Like,
is that something that's a sign ora signal of proclemsia or something that
might be going wrong Because I rememberbeing very, very very very tiny and

(14:54):
then all of a sudden I gainedalmost close to eighty more pounds during my
pregnancy. Wow. So and noone said, hey, that's a lot
of weight, right, It canbe you know, weight gain can happen
from lots of different reasons, butthat is one of the things that we
look at. If there's a bigjump in weight in the third trimester,

(15:16):
that can sometimes be a sign ofpre eclamsia. But again, to be
clear, the lotos aspirin is prevention. It is not treatment. So it's
prevention that you want to start earlyin pregnancy. By the time you get
to the signs and symptoms of preclamsiathat's usually towards the end of pregnancy.

(15:39):
But what we're trying to do isget to prevention so that people don't end
up with the pre aclamsia. Yeah, that's a really good way of articulating
it, because prevention is really thekey. Right. Sure, you don't
want to start treating the problem whenyou have the problem. You want to
get way ahead of it. You'vegot it in terms of the research,

(16:00):
right and like the next steps oflike what this all looks like from a
data standpoint. I mean, wheredo you see the I guess the pilgrimage
of low dose aspirin and it's inits placed in the world of medicine and
prevention. Well, I've said listen, I go, you go, Ana,
you go first. Well, Iwas gonna say where our research is

(16:22):
right now is looking at efficacy ofusing the low dose aspirin in different populations
for preventing preaclamsia. Now, oneof the things, and not to nerd
out for people around data science,but the prevention, medication, the prescribing,

(16:42):
that's all in the outpatient world,that's in the clinics, that's in
the offices. But the pre acclamsiadiagnosis is mostly happening in hospitals, so
there's a big data gap there ina lot of places between knowing what's happening
in the office world versus knowing what'shappening in the hospital world. So it's

(17:03):
actually a rather difficult problem to tryto solve. It's something we're working really
hard with our Maternal Data Center inCalifornia, where we all are part of
a big collaborative. Every maternity hospitalin California is part of this and puts
our data into one system, whichis how we've been able to do a
lot of this research. But wewant to know is it the highest risk

(17:27):
patients, the ones who have twins, who have lupus, who have chronic
hypertension, We want to look atthe impact for them, And then we
want to look at the impact forpatients with demographic risk factors, things like
obesity, exposure to systemic racism,age over thirty five, low socioeconomic status,

(17:51):
things that put us at risk notbecause there's something wrong with our bodies,
but because of the toxic stress ofexisting in America with all of these
demographic features. So we have totry to understand that better and these conversations
are not easy ones to have.Man, you're so good, Amanda.

(18:14):
It's like so exciting to think abouthow we could pull that data and the
impact we could have. And Ithink that's why we got excited when right
when I for March of Dimes firststarted talking to about this data, because
it is truly right. There isn'tjust take your aspirin and you're done.
There's so much more to look athere and to your point of being an
outpatient, So really trying to getinto a quality improvement program is really where

(18:41):
we're heading for the future to lookat this Kenya, and so we know
that there's been pockets of this done. California is doing it, but there
isn't great like nerding out in thatway in other places where all that data
sits. And so March of Dimesis excited to kind of get involved here,
to be able to help right andto be able to be a convenior
that could bring us together to reallylook at that because we've got to look

(19:02):
at everything from you know, didto get introduced, was it taken,
was there compliance to then you know, the outcomes and who in the community
really and get to those stories behindthe data to get to what right we
know for implementation. So I getreally excited what a man talk about.
Yeah, it's a good nerding outright, you know. And I love

(19:26):
doctor Williams that you brought up alot of those external factors, right,
because a lot of you know,and sometimes we don't we pay attention a
lot of times to what environmentally isgoing on with us, right, But
there's a lot of things from asocietal standpoint that are going on with us
that we don't actually have a quickfix or a solve for. But we've
learned how to cope and we've manyou know, to manage, so you

(19:47):
know, it'd be great to solvesome of those other things. So there's
not this other component to it all. But it's also refreshing to know that
we do now have this data andresearch and a solution that will help offset
right some of the potential harmful thingsthat can come from those external factors from
stress, you know, that leadto negative impact on the body. So

(20:08):
it's refreshing to hear that even thatthought process is in place and that it's
being implemented at this level. Well, you know, we saw on TikTok
there was a gal who was reallyangry about her doctor telling her that she
needs to be on lotos aspect.She has, Oh you're fat, you're
black, you got to be onlotos aspirt and I'm like, no,

(20:30):
I do not. That is notwhat defines me. And it was so
impactful because it made me realize there'ssuch a breakdown of trust and such poor
communication that happened between the doctor whothought that they were doing the right thing,
said like, Okay, this personhas risk factors, but absolutely dropped

(20:52):
the ball on communication with the patient. So instead, you know, to
have that conversation and say, look, I want you to have the best
outcome possible. I want your babyto have the lowest likelihood of ending up
in the neonatal intensive care unit forlow birth rate. We don't totally understand
it, but we know that demographicrisk factors like being low income, like

(21:18):
being exposed to systemic racism, likebeing over thirty five, like having ten
years since your last pregnancy, thesethings do increase your risk. And I
can't take away that toxic stress fromyour body, but what I can do
is try to help keep it fromimpacting your placenta and keep you and your

(21:38):
baby safe. So I am recommendingthat you go on low do's aspirin to
put yourself in the best position possiblefor a healthy mom and baby. If
that conversation had happened, it mighthave been really different. Right. We
need to record that and replay itfor everything, over and over and over

(21:59):
again. And I know March ofDimes has a bunch of resources and information,
a whole pretty much toolkit that Iwas given and exposed to about resources
that are available out there, andthey are on our me eternal dot info
website. But doctor Chiro, wherecan folks find more information about how March
of Dimes is expanding the conversation further? So it's the March of Dimes dot

(22:22):
org. It's the backslash for LDAfor low dos, big benefits. And
I would also say that a lotof this stuff was built out of California.
So I have to thank Amanda andher team because it was like huge
for usvel lean in there. Sothank you, thank you so much.
I'm so excited to partner on thiswork and to make it make it happen

(22:45):
again. Like I said before,those were some of the darkest days and
it's very it's it's coming up soon. It is my son's birthday. But
those are some of the darkest daysof my life. And if I can
keep that from happening for other people, that has to be part of my
personal mission as a physician on thisplanet. So we gotta, we gotta

(23:08):
make it happen. I'm so gladwas to be in this work together and
Kenya for you to give us theopportunity to connect to more patients and to
empower them with what they need tohave the healthiest pregnancy possible. Well,
it's my pleasure and the great pleasureof me Eternal, which is a platform

(23:29):
that exists because of March of Dimes, right, So because of our partnership,
we're able to expand this type ofinformation and resources to our audiences.
So I just want to say thankyou to March of Dimes as well,
because we can't do this work withoutyou. So it's it's definitely been a
collaborative effort. And before we kindof sign off here, I just want
to talk about like what the nextphase of your partnership looks like with each

(23:52):
other, Amanda, do you wantto announce it or do you want me
you do it? So Amanda isjoining our National Medical Advisory Council. She's
our inaugural person to join. Ithink you, Ken and I have talked
about when I joined a CMO andthen jumping over to CEO, and I'm
so excited to have this council startand really a man is going to lead

(24:15):
the way. She's our inaugural person, so she's breaking it all in for
us, but more importantly is reallyhaving that voice, that clinical voice to
be able to be out there supportingus but also you know, us supporting
kind of where she is and whatshe's doing. But we're just so excited
that the partnership and it's just begun. We just finally got into where we

(24:37):
can announce and excited to have heron board. And I'm so excited to
be there and to be able totake this work that we started at CMQCC
in California and to let it growand to help be a spokesperson around the
country. Yeah, that's amazing.Yes, she's start your rock star and

(25:00):
so has right and knowledgeable and that'sjust the best combination you want to have,
especially when you're in this kind ofwork, right because I know it's
it's a great task. But you'regetting it done. You're getting it done,
and it's impressive. It's very veryimpressive. So anything else that folks
should know before we you know,sign off here. How can they get
in touch with you if anyone hasquestions or you know, there's more resources

(25:23):
and information available, What is thebest place that they should visit? So
well, you go, you go. Oh, she looked like she paused.
Okay, So for us, it'sthat marshodimes dot org gets the Backslash
Load Dose Toolkit gets into the toolkitof all the information for patients to read.

(25:45):
And I you know, you canget to our website and get there
just by going to March Dimes dotorg. But if you go to the
Backslash Low Dose Toolkit you'll find itall, which is really exciting. Great,
that's awesome. That's awko. Yes, this was a great. Oh
my god, thank you. Thiswas great. I appreciate you, you
know, tuning in and just kindof keeping this thing going because the reality

(26:08):
is is people need this information right, this is important. We have to
continue to have these conversations. AndI just want to thank you March of
Dimes doctor Williams for being on thepodcast. Today, and you're listening to
Me Eternal on iHeartRadio, joined todayby doctor Elizabeth Chirou, the CEO of
March of Dimes, and doctor AmandaWilliams. Until next time, right, great
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