Aspirin Use to Prevent Preeclampsia: USPSTF Recommendation

Davidson KW, Barry MJ, Mangione CM, et al., on behalf of the US Preventive Services Task Force.
Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: US Preventive Services Task Force Recommendation Statement. JAMA 2021;326:1186-1191.

The following are key points to remember from the US Preventive Services Task Force (USPSTF) recommendation statement on the use of aspirin to prevent preeclampsia and related morbidity and mortality:

  1. Preeclampsia is a complication in approximately 4% of pregnancies in the United States, and accounts for 6% of preterm births and 19% of medically indicated preterm births in the United States.
  2. Non-Hispanic Black women are at increased risk for preeclampsia and have higher rates of maternal and infant morbidity and mortality.
  3. The USPSTF commissioned a systematic review to evaluate the effectiveness of low-dose aspirin to prevent preeclampsia, which strengthened their 2014 recommendation.
  4. Low-dose aspirin reduces the risk of preeclampsia, preterm birth, small for gestational age/intrauterine growth restriction, and perinatal mortality in pregnant persons with risk factors for preeclampsia.
  5. High-risk factors for preeclampsia include: history of preeclampsia (especially when accompanied by an adverse outcome), multifetal gestation, chronic hypertension, pregestational type 1 or 2 diabetes, kidney disease, and autoimmune disease (i.e., systemic lupus erythematosus, antiphospholipid syndrome). If one or more of these high-risk factors are present, the USPSTF recommends low-dose aspirin.
  6. Moderate-risk factors for preeclampsia include: nulliparity, obesity (i.e., body mass index >30 kg/m2), family history of preeclampsia (i.e., mother or sister), Black persons (due to social, rather than biological, factors), lower income, age 35 years or older, personal history factors (e.g., low birth weight or small for gestational age, previous adverse pregnancy outcome, >10-year pregnancy interval), or in vitro conception. If two or more of these moderate-risk factors are present, the USPSTF recommends low-dose aspirin (may consider low-dose aspirin if one of these risk factors is present).
  7. Of note, most studies initiated low-dose aspirin before 20 weeks of gestation. The American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine recommend low-dose aspirin be initiated between 12 and 28 weeks of gestation (optimally before 16 weeks) and continued daily until delivery.
  8. Additionally, the USPSTF recommends all women capable of pregnancy take a daily supplement of folic acid 0.4-0.8 mg (400-800 mcg) to prevent neural tube defects.
  9. Summary: The USPSTF recommends low-dose aspirin (81 mg/day) as preventive medication after 12 weeks of gestation for women at increased risk for preeclampsia.

Keywords: African Americans, Aspirin, Body Mass Index, Diabetes, Gestational, Fetal Growth Retardation, Folic Acid, Gestational Age, Hypertension, Infant, Newborn, Kidney Diseases, Lupus Erythematosus, Systemic, Neural Tube Defects, Obesity, Parity, Perinatal Mortality, Pre-Eclampsia, Pregnancy, Pregnancy Outcome, Premature Birth, Primary Prevention, Risk Factors, Secondary Prevention, Women

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