USPSTF recommends low-dose aspirin to prevent preeclampsia in high-risk patients
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The U.S. Preventive Services Task Force has released draft guidance today that recommends 81 mg of aspirin daily as preventive medication for preeclampsia in high-risk patients who are more than 12 weeks pregnant.
Women who have type 1 or type 2 diabetes mellitus, chronic hypertension, renal disease or autoimmune disease have the highest risk for developing preeclampsia. Other women at high risk include those with high pre-pregnancy BMI, multifetal gestation, a family or personal history of preeclampsia and related serious complications in a prior pregnancy, as well as women aged older than 35 years, according to the task force.
USPSTF reported that preeclampsia is the second-most common cause of maternal morbidity and mortality worldwide. The condition occurs in approximately 4% of U.S. pregnancies and accounts for 6% of preterm births and 19% of medically indicated preterm births in the United States. According to a study from non-USPSTF task force members, a baby born before 37 weeks of pregnancy is considered a “preterm birth.” A baby that has to be delivered by cesarean section to an illness to the mother or infant is considered a “medically indicated preterm birth.”
The task force also noted that there are racial and ethnic disparities in the prevalence of and mortality from preeclampsia.
“It is essential that the health community focus on why the disparities exist and what changes can be made to improve health outcomes for Black people and their babies,” Michael Silverstein, MD, MPH, a task force member and a professor of pediatrics at Boston University School of Medicine, said in a press release. “The task force is committed to addressing this disparity and is calling for more research on how best to prevent preeclampsia in Black people who are pregnant.”
According to the USPSTF, the B statement is consistent with the task force’s 2014 final recommendation in this clinical area, as well as recommendations from the American College of Obstetricians and Gynecologists, the American Heart Association/American Stroke Association and WHO.
The new USPSTF draft recommendation is based on 18 randomized controlled trials that assessed maternal and perinatal health outcomes in 15,908 patients. In general, trial participants had a mean age of 20.4 to 33.5 years and were white. Trials since the 2014 recommendation contained new evidence that showed low-dose aspirin use reduced the risk for perinatal mortality, the task force said.
“A large body of trial evidence shows no clear signal of serious harms associated with daily low dose aspirin use in the second and third trimesters of pregnancy,” authors of the evidence update wrote.
The task force will accept comments on its draft recommendation until March 22 via its website: www.uspreventiveservicestaskforce.org/tfcomment.htm.
References:
Henderson JT, et al. Aspirin use to prevent preeclampsia and related morbidity and mortality: An evidence update for the U.S. Preventive Services Task Force. Accessed February 16, 2021.
Stout MJ, et al. Am J Obstet Gynecol. 2014;doi:10.1016/j.ajog.2014.05.023.