Aspirin Treatment for Women at Risk for Preeclampsia – ACOG and USPSTF Recommendations
ACOG and SMFM have released guidance, stating that they “support the USPSTF guideline criteria for prevention of preeclampsia” on the use of low-dose aspirin during pregnancy to prevent preeclampsia. When indicated, low-dose aspirin should be started between 12 to 28 weeks and continued until delivery. Optimally, aspirin usage should begin <16 weeks.
Recommended (high risk)
Offer low-dose aspirin (81 mg/day) to women with ≥1 high risk factors for preeclampsia, which include
History of preeclampsia, especially if accompanied by an adverse outcome
Diabetes (Type 1 or Type 2)
Autoimmune disease (for example, systematic lupus erythematosus, antiphospholipid syndrome)
Consider Prophylaxis (moderate risk)
Offer low-dose aspirin (81 mg/day) to women with >1 moderate risk factors for preeclampsia, which include
The USPSTF recommends the use of low-dose aspirin (81 mg/d) as preventive medication for preeclampsia after 12 weeks of gestation in persons who are at high risk for preeclampsia. (B recommendation – offer or provide this service)
The most recent systematic evidence review (see ‘Learn More – Primary Sources) provided more precise estimate of the association between aspirin and the prevention of perinatal mortality (4% to 44% reduction in fetal and neonatal deaths)
Otherwise, benefits of low-dose aspirin for women at risk for preeclampsia were similar to previous reviews with lower risks for the following (moderate certainty)
Preeclampsia: Pooled relative risk (RR) 0.85 (95% CI, 0.75-0.95)
Perinatal mortality: Pooled RR 0.79 (95% CI, 0.66-0.96)
Preterm birth: Pooled RR 0.80 (95% CI, 0.67-0.95)
Intrauterine growth restriction: Pooled RR 0.82 (95% CI, 0.68-0.99)
No significant association was found for
PPH or other bleeding-related harms
Rare perinatal or longer-term harms
Long-term child developmental outcomes in offspring from in utero exposure to low-dose aspirin
Follow-up data from the Collaborative Low-dose Aspirin Study in Pregnancy (CLASP), found no differences in physical or developmental outcomes at 12 to 18 months
The USPSTF uses the same clinical assessment as above based on high vs moderate risk
However, note following changes for moderate risk category
Recommend low-dose aspirin if ≥2 moderate risk factors
Consider low-dose aspirin if 1 moderate factor is present
Systemic racism: “Black persons (due to social, rather than biological, factors)” is included
IVF conception is included
Risk factors used for ACOG/SMFM recommendations only include factors obtained from the medical record
Uterine artery Doppler ultrasonography and biochemical markers are not included
ACOG/SMFM acknowledge that other studies, in particular the ASPRE trial (see ‘Related ObG Topics’ below), have incorporated ultrasound and maternal serum markers as well as doses >81 mg, but state
Further, the screening algorithm used includes first-trimester serum markers, including placental growth factor and pregnancy-associated plasma protein-A, as well as uterine artery dopplers, which limits the generalizability to a U.S. population. Therefore, a higher dose or doubling of the available 81-mg dose cannot be recommended at this time.
Screening for Preeclampsia
Various studies have incorporated not only clinical risk factors but also biochemical markers and ultrasound to determine which women are at risk for early onset preeclampsia and may benefit from aspirin prevention (see ‘Related ObG Topics’)
ACOG considers the supporting data for the use of such combined risk assessment algorithms to be limited and without more prospective clinical utility trials, states that
…biomarkers and ultrasonography cannot accurately predict preeclampsia and should remain investigational.
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan