Prevalence of preeclampsia risk factors: implications for low-dose aspirin prophylaxis

Abstract

In patients with risk factors for preeclampsia, prophylactic low-dose aspirin administration reduces the rates of preeclampsia, preterm birth, fetal growth restriction, and perinatal death. 1 Henderson JT Vesco KK Senger CA Thomas RG Redmond N. Aspirin use to prevent preeclampsia and related morbidity and mortality: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2021; 326: 1192-1206 Google Scholar In September 2021, the US Preventive Services Task Force (USPSTF) issued an updated Recommendation Statement regarding prophylactic low-dose aspirin use 2 Davidson KW Barry MJ US Preventive Services Task ForceAspirin use to prevent preeclampsia and related morbidity and mortality: US Preventive Services Task Force recommendation statement. JAMA. 2021; 326: 1186-1191 Google Scholar based on an updated USPSTF Evidence Review. 1 Henderson JT Vesco KK Senger CA Thomas RG Redmond N. Aspirin use to prevent preeclampsia and related morbidity and mortality: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2021; 326: 1192-1206 Google Scholar Major changes from the 2014 USPSTF recommendations and the 2018 Committee Opinion by the American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal-Fetal Medicine (SMFM) 3 ACOG Committee Opinion No. 743: Low-dose aspirin use during pregnancy. Obstet Gynecol. 2018; 132: e44-e52 Google Scholar include that low-dose aspirin is now “recommended” for patients with ≥2 moderate-risk factors (previously “considered”); low-dose aspirin is now to be considered for patients with 1 moderate-risk factor (new recommendation); in vitro fertilization (IVF) has been added to the list of moderate-risk factors (new recommendation); and there is no upper gestational age limit for initiating low-dose aspirin administration (previously 28 weeks). All these changes favor more liberal use of aspirin.