Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality

Abstract

ImportancePreeclampsia is one of the most serious health problems that affect pregnant persons. It is a multisystem inflammatory syndrome that is often progressive but has an unclear etiology. Worldwide, preeclampsia is the second most common cause of maternal morbidity and mortality. It is a complication in approximately 4% of pregnancies in the US and contributes to both maternal and infant morbidity and mortality. 1 Preeclampsia also accounts for 6% of preterm births and 19% of medically indicated preterm births in the US. 1 There are racial and ethnic disparities in the prevalence of and mortality from preeclampsia. Non-Hispanic Black women are at greater risk for developing preeclampsia than other women and experience higher rates of maternal and infant morbidity and perinatal mortality than other racial and ethnic groups. In the US, the rate of maternal death from preeclampsia is higher among non-Hispanic Black women than non-Hispanic White women. 1,2 Disparities in risk factors for preeclampsia, access to early prenatal care, and obstetric interventions may account for some of the differences in prevalence and clinical outcomes. 1 These disparities largely result from historical and current manifestations of IMPORTANCE Preeclampsia is one of the most serious health problems that affect pregnant persons. It is a complication in approximately 4% of pregnancies in the US and contributes to both maternal and infant morbidity and mortality. Preeclampsia also accounts for 6% of preterm births and 19% of medically indicated preterm births in the US. There are racial and ethnic disparities in the prevalence of and mortality from preeclampsia. Non-Hispanic Black women are at greater risk for developing preeclampsia than other women and experience higher rates of maternal and infant morbidity and perinatal mortality.OBJECTIVE To update its 2014 recommendation, the USPSTF commissioned a systematic review to evaluate the effectiveness of low-dose aspirin use to prevent preeclampsia.POPULATION Pregnant persons at high risk for preeclampsia who have no prior adverse effects with or contraindications to low-dose aspirin.EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that there is a substantial net benefit of daily low-dose aspirin use to reduce the risk for preeclampsia, preterm birth, small for gestational age/intrauterine growth restriction, and perinatal mortality in pregnant persons at high risk for preeclampsia.RECOMMENDATION The USPSTF recommends the use of low-dose aspirin (81 mg/d) as preventive medication for preeclampsia after 12 weeks of gestation in persons who are at high risk for preeclampsia. (B recommendation)

Prevention of pre‐eclampsia with aspirin: A systematic review of guidelines and evaluation of the quality of recommendation evidence

“…Before resolving discrepancies, the reviewers had an agreement of 98% for the inclusion of full texts. A total of 48 statements met the final inclusion criteria 25–72 : 34 (71%) were CPGs developed by a panel following a systematic search to inform practitioners and patients 25–56,69,71 and 14 (29%) were position papers, consensus statements, or lacked detailed methodology (Table 1), which prevented them from being considered a CPG (Table S1). 57–68,70,72 …”

The Enzyme 15-Hydroxyprostaglandin Dehydrogenase Inhibits a Shift to the Mesenchymal Pattern of Trophoblasts and Decidual Stromal Cells Accompanied by Prostaglandin Transporter in Preeclampsia

“…Therefore, the precise regulation of prostaglandin metabolism is very important for the formation of the maternal–foetal interface. Aspirin, as an inhibitor of prostaglandin synthase COX-2, has been widely used in the clinic to prevent PE [ 23 , 24 ]. PGT and 15-PGDH also play important roles in regulating prostaglandin concentrations.…”

Preeclampsia pathophysiology and adverse outcomes during pregnancy and postpartum

“…Various countries have different screening protocols to identify patients who will benefit from aspirin therapy. Current screening in the United States consists of the identification of major and moderate risk factors for preeclampsia development ( Table 2 ) ( 70 ). Patients with one major and more than one moderate risk factor for preeclampsia are considered candidates for aspirin therapy.…”