Abstract
Low-dose aspirin (LDA) is one of the few evidence-based interventions for preventing preeclampsia, which is a leading cause of maternal or fetal morbidity and mortality. Current guidelines recommend LDA based on the presence of risk factors for preeclampsia, but the population-based prevalence of these factors is unknown. To estimate population-level prevalence of preeclampsia risk factors used in prophylactic LDA guidelines for pregnant patients and the association of these risk factors with reported rates of pregnancy-related hypertension. A retrospective cohort study was conducted using National Center for Health Statistics birth certificate data to describe the frequency of pregnant individuals with moderate to high-risk factors for preeclampsia and pregnancy-related hypertension rates. The study used all birth records in the United States for the 2019 calendar year. Documentation of preeclampsia risk factors: multifetal gestation, pregestational diabetes, chronic hypertension (high-risk factors) and nulliparity, a body mass index greater than 30, African American race, a maternal age 35 years or older, an interval of more than 10-years since last birth, and having low socioeconomic status (moderate risk factors). Prevalence of each risk factor alone and in combinations leading to a recommendation for LDA; incidence of pregnancy-related hypertension by risk factor and combinations of risk factors. There were 3 695 019 pregnancies in 2019, including 528 778 with no risk factors, 169 540 with 1 or more high-risk factors, and 2 996 701 with 1 or more moderate-risk factors. The mean (SD) of the cohort was 29.1 (5.8) years. Multifetal gestation was the most common high-risk factor and found in 123 995 pregnancies (3.4%), and low socioeconomic status was the most common moderate-risk factor and present in 1 732 729 pregnancies (46.9%). Based on 2021 criteria (a single high- or moderate-risk factors for preeclampsia), 3 166 241 pregnant patients (85.7%) were eligible for LDA. The incidence of pregnancy-related hypertension increased with the number of moderate-risk factors. The 2021 guidelines suggest considering or recommend LDA in 92.3% of pregnancies diagnosed with pregnancy-related hypertension. These data support the recently published guidelines and suggest further simplified guidelines recommending LDA to patients with any single moderate-risk factors.
Highlights
The incidence of pregnancy-related hypertension increased with the number of moderaterisk factors
The 2021 guidelines suggest considering or recommend low-dose aspirin (LDA) in 92.3% of pregnancies diagnosed with pregnancy-related hypertension
Preeclampsia is a systemic hypertensive condition marked by elevated blood pressures and proteinuria that is unique to pregnancy
Summary
Preeclampsia is a systemic hypertensive condition marked by elevated blood pressures and proteinuria that is unique to pregnancy. The United States Preventive Services Task Force (USPSTF) recommends LDA (81 mg/d) for the prevention of preeclampsia in individuals with a preeclampsia risk of 8% or higher, based on the presence of certain known risk factors.[4]. The 2014 USPSTF are complex, with a definite recommendation for LDA if 1 or more of 6 highrisk factors and consideration of LDA 2 or more of 11 moderate-risk factors are present. The 2021 guidelines recommend for LDA for a combination of moderate-risk factors and encourage consideration if a single moderate-risk factor is present. Given the continued complexity of these recent guidelines, the overall safety of LDA in pregnancy, and the potential consequences of preeclampsia for maternal and fetal outcomes, some researchers have argued for universal use of LDA in all pregnant individuals.[5,6]
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