USPSTF recommendation for aspirin use to prevent preeclampsia and related morbidity and mortality

Sept. 30, 2021

Updated recommendations have been released by the US Preventive Services Task Force (USPSTF). For pregnant persons at high risk for preeclampsia the USPSTF recommends the use of low-dose aspirin (81 mg/day) as preventive medication after 12 weeks of gestation in persons who are at high risk for preeclampsia.

This applies to asymptomatic pregnant persons who are at high risk for preeclampsia and have no prior adverse events with low-dose aspirin. The recommendation is strengthened by new evidence from additional trials demonstrating reduced risks of perinatal mortality with aspirin use.

In order to assess risk, the recommendations instruct clinicians to determine if a pregnant person is at high risk for preeclampsia when obtaining the patient medical history. Pregnant persons are at high risk for preeclampsia if they have 1 or more of the following risk factors:

History of preeclampsia

  • Multifetal gestation
  • Chronic hypertension
  • Pregestational type 1 or 2 diabetes
  • Renal disease
  • Autoimmune disease (ie, systemic lupus erythematous, antiphospholipid syndrome)

Combinations of multiple moderate-risk factors may be used, such as nulliparity (having never given birth), obesity (ie, BMI >30), family history of preeclampsia (ie, mother, sister), maternal age of 35 years or older, personal history factors (eg, low birth weight or small for gestational age, previous adverse pregnancy outcome, >10-year pregnancy interval), in vitro fertilization conception, and lower income. Black persons are associated with increased risk due to environmental, social, and historical inequities shaping health exposures, access to healthcare, and the unequal distribution of resources, not biological propensities.

Prescribe. 

If patient is at high risk for preeclampsia, prescribe low-dose aspirin (81 mg/d) after 12 weeks of gestation. The USPSTF recommends that all women planning or capable of pregnancy take a daily supplement containing 0.4 to 0.8 mg (400 to 800 µg) of folic acid.

USPSTF report

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