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Grand Rounds

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

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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

METHODS:

  • 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

RESULTS:

  • 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 

CONCLUSION:

  • 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

Learn More – Primary Sources:

Estimated Prevalence of Risk Factors for Preeclampsia Among Individuals Giving Birth in the US in 2019

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Related ObG Topics:

ASPRE Trial: A Combined Risk Algorithm and Use of Aspirin to Prevent Preterm Preeclampsia
Results from the SPREE Trial: How Does First Trimester Preeclampsia Screening Compare to Current Guidelines?
Is Aspirin for Early Preeclampsia Prophylaxis Cost-Effective?

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