USPSTF affirms recommendations regarding use of aspirin to prevent preeclampsia

The U.S. Preventive Services Task Force said it was maintaining a stance it took in 2014 and recommended the use of low-dose aspirin to prevent preeclampsia after 12 weeks of pregnancy in women who are at high risk for the condition.

Although the level of the recommendation — B — remains unchanged, “it is strengthened by new evidence from additional trials demonstrating reduced risks of perinatal mortality with aspirin use,” the USPSTF wrote in JAMA.

New incident data have also emerged since the last USPSTF recommendation, according to the authors of a corresponding evidence report. There were 46.6 cases of preeclampsia for every 1,000 deliveries in the United States in 2014, an increase from 38.4 cases per 1,000 deliveries in 2005. There has also been an increase in preeclampsia “with severe features,” and the condition occurring “in the presence of chronic hypertension,” especially in Black women over the same 10-year period, the authors wrote.

The USPSTF recommendation aligns with guidance from WHO and the American Heart Association/American Stroke Association, the task force wrote, while the American College of Obstetricians and Gynecologists has stated that women at risk for preeclampsia may choose to wait until their 28th week of pregnancy to start the low-dose daily aspirin regimen.

The recommendation does not mean every pregnant woman should start taking low-dose aspirin, Aaron Caughey, MD, MPP, MPH, PhD, a task force member and chair of the department of obstetrics and gynecology and the associate dean for women’s health research and policy at Oregon Health & Science University, said in a press release.

“It’s important for clinicians to take into account a number of health factors that increase preeclampsia risk,” he said. These factors include a woman’s medical history of preeclampsia, the expectation of a non-singleton birth, a high BMI prior to pregnancy, high BP and diabetes, a family history of preeclampsia, becoming pregnant at an older age and being a Black woman.

In a related editorial, Jimmy Espinoza, MD, MSc, the co-director of the Fetal Center at Texas Children's Hospital and associate professor at the Baylor College of Medicine, wrote that many of the trials the USPSTF used to reach its recommendation lacked Black and Hispanic women, leaving the applicability of the USPSTF recommendation to underrepresented populations unclear.

Michael Silverstein, MD, MPH, a USPSTF member and associate chief medical officer for research and population health at Boston Medical Center, Boston University School of Medicine, called for more research with diverse populations.

“The task force is committed to addressing these inequities, and we are calling for more research on how to best prevent preeclampsia in Black people who are pregnant so that this disparity can be addressed in the health community,” he said in a press release.

References:

Espinoza J. JAMA. 326(12):1153-1555.

Henderson JT, et al. JAMA. 2021; doi:10.1001/jama.2021.855.

USPSTF. JAMA. 2021; doi:10.1001/jama.2021.14781.

U.S. Preventive Services Task Force publishes final recommendation statement on aspirin use for the prevention of preeclampsia. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/low-dose-aspirin-use-for-the-prevention-of-morbidity-and-mortality-from-preeclampsia-preventive-medication. Published Sept. 28, 2021. Accessed Sept. 28, 2021.