Grand Rounds

Is There a Case to be Made for Universal Low-Dose Aspirin for Preeclampsia Prevention in the United States?

BACKGROUND AND PURPOSE:

Wheeler et al. (JAMA Network Open, 2022) estimated population-level prevalence of preeclampsia risk factors used in prophylactic low-dose aspirin (LDA) guidelines for pregnant patients

Retrospective cohort study
Population
- All birth records in the United States for the 2019 calendar year
Preeclampsia risk factors
- High-risk factors
  - Multifetal gestation
  - Pregestational diabetes
  - Chronic hypertension
- Moderate-risk factors
  - Nulliparity
  - A BMI >30
  - African American race
  - Maternal age ≥35 years
  - >10-year interval since last birth
  - Low socioeconomic status
Primary outcomes
- Prevalence of risk factors used for LDA recommendation
- Incidence of pregnancy-related hypertension by risk factor and combinations of risk factors

3,695,019 pregnancies
- Mean (SD) age of cohort: 29.1 (5.8) years
- Risk factors
  - No risk factors: 528,778
  - ≥1 high-risk factors: 169,540
  - ≥1 moderate-risk factors: 2,996,701
Most common high-risk factor: Multifetal gestation (3.4%)
Most common moderate-risk factor: Low socioeconomic status (46.9%)
Pregnancies eligible for LDA, based on 2021 criteria (a single high- or moderate-risk factors for preeclampsia): 85.7%
Incidence of pregnancy-related hypertension increased with the number of moderate-risk factors
Needed to Treat (NNT) only slightly increased for universal treatment
- Single moderate-risk factor when LDA is considered: 76
- Universal treatment: 82

85% of pregnancies in the US in 2019 met the guidelines recommending low-dose aspirin for prevention of preeclampsia
The authors suggest that guidelines for recommending LDA to patients could be simplified with universal approach

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