Low-Dose Aspirin and Preeclampsia Prevention.

[Argirios Argiriou]

September 18, 2014
Low-Dose Aspirin and Preeclampsia Prevention
Allison Bryant, MD, MPH reviewing USPSTF. Ann Intern Med 2014 Sep 9.

The USPSTF recommends daily low-dose aspirin after 12 weeks' gestation for pregnant women at high risk for preeclampsia.

Sponsoring Organization: U.S. Preventive Services Task Force (USPSTF)

Target Population: Obstetric care providers

Background and Objective

In 1996, the USPSTF concluded that the evidence was not strong enough to recommend for or against routine use of aspirin for preventing preeclampsia. Since then, the group has conducted a meta-analysis (AHRQ [US]; 2014 Apr [Report 14-05207-EF-1]) of all available data and has issued new guidelines.

Key Recommendations

    In women at high risk for preeclampsia, low-dose aspirin reduces the likelihood of preeclampsia, preterm birth, and intrauterine growth restriction.

    Women are considered high-risk if they have had preeclampsia in a prior pregnancy; are pregnant with multiple gestations or have comorbidities such as hypertension, diabetes, or renal disease; or if they have several moderate risk factors (e.g., obesity, nulliparity, prior adverse pregnancy outcomes, black race, age >35).

    “Low-dose” is defined as 60 mg to 150 mg daily.

    Aspirin should be started after 12 weeks' gestation.

Comment

Low-dose aspirin does not seem to be associated with maternal or fetal harm. The USPSTF reiterates its recommendation that all women capable of pregnancy take a supplement that provides 400 µg to 800 µg daily folate. Their recommendations for aspirin use differ slightly from those of the American College of Obstetricians and Gynecologists, which recommends that 60 mg to 80 mg daily aspirin be started during the late first trimester only for those women with a prior preterm birth (<34 weeks) complicated by preeclampsia and those with histories of preeclampsia in more than one previous pregnancy (Obstet Gynecol 2013; 122:1122). Daily aspirin is relatively safe and inexpensive. Evidence suggests this therapy lowers preeclampsia risk by 24% and risk for preterm birth by 14% — reductions that could go a long way toward reducing the domestic and global burdens of this disease.

Citation(s):

    USPSTF.Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2014 Sep 9; [e-pub ahead of print]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

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