Recommendations for Use of Low Aspirin to Prevent Preeclampsia

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Preeclampsia is one of the most deadly medical problems affecting pregnant women. Preeclampsia complicates up to 10% of pregnancies worldwide and contributes to both maternal and infant morbidity and mortality as well as accounting for about 1 in 7 preterm births in the United States.

Below are the most recent recommendations made by the American Congress of Obstetricians and Gynecologists (ACOG) and the U.S. Preventive Services Task Force.

High Risk Factors

  • History of preeclampsia, especially when accompanied by an adverse outcome
  • Multifetal gestation
  • Chronic hypertension
  • Type 1 or 2 diabetes
  • Renal disease
  • Autoimmune disease (systemic lupus erythematous, antiphospholipid syndrome)

Recommendations for High Risk Factors:  Recommend low-dose aspirin if the patient has ≥1 of these high-risk factors

Moderate Risk Factors

  • Nulliparity
  • Obesity (body mass index >30 kg/m2)
  • Family history of preeclampsia (mother or sister)
  • Sociodemographic characteristics (African American race, low socioeconomic status)
  • Age ≥35 years
  • Personal history factors (e.g., low birthweight or small for gestational age, previous adverse pregnancy outcome, >10-year pregnancy interval)

Recommendations for Moderate Risk Factors: Consider low-dose aspirin if the patient has several of these moderate-risk factors

Low Risk Factors
Previous uncomplicated full-term delivery

Recommendations for Low Risk Factors: Do not recommend low-dose aspirin

  • Includes only risk factors that can be obtained from the patient medical history. Clinical measures, such as uterine artery Doppler ultrasonography, are not included.
  • Single risk factors that are consistently associated with the greatest risk for preeclampsia. The preeclampsia incidence rate would be approximately ≥8% in a pregnant woman with ≥1 of these risk factors1.
  • A combination of multiple moderate-risk factors may be used by clinicians to identify women at high risk for preeclampsia. These risk factors are independently associated with moderate risk for preeclampsia, some more consistently than others.
  • Moderate-risk factors vary in their association with increased risk for preeclampsia.
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