Abstract
BackgroundPreeclampsia (PE) increases maternal and perinatal morbidity and mortality. Based on a multitude of data from randomized clinical trials, clinical practice guidelines endorse using ASA to prevent PE in women who are “at risk.” However, data are lacking about the level of absolute risk to warrant starting ASA prophylaxis.Methods and FindingsWe present two approaches for objectively determining the minimum absolute risk for PE at which ASA prophylaxis is justified. The first is a new approach—the minimum control event rate (CERmin). The second approach uses a pre-existing concept—the minimum event rate for treatment (MERT). Here we show how the CERmin is derived, and then use the CERmin and the MERT to guide us to a reasonable risk threshold for starting a woman on ASA prophylaxis against PE based on clinical risk assessment. We suggest that eligible women need not be at “high risk” for preeclampsia to warrant ASA, but rather at some modestly elevated absolute risk of 6–10%.ConclusionsGiven its very low cost, its widespread availability, ease of administration and its safety profile, ASA is a highly attractive agent for the prevention of maternal and perinatal morbidity worldwide.
Highlights
Preeclampsia (PE) increases maternal and perinatal morbidity and mortality
We show how the CERmin is derived, and use the CERmin and the minimum event rate for treatment (MERT) to guide us to a reasonable risk threshold for starting a woman on Acetylsalicylic acid (ASA) prophylaxis against PE based on clinical risk assessment
Women with PE have a higher risk of placental abruption, and their fetuses have a higher risk of stillbirth, preterm delivery, and intrauterine growth restriction [8,9,10]
Summary
Preeclampsia (PE) increases maternal and perinatal morbidity and mortality. Based on a multitude of data from randomized clinical trials, clinical practice guidelines endorse using ASA to prevent PE in women who are “at risk.” data are lacking about the level of absolute risk to warrant starting ASA prophylaxis.
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