Annals of Internal Medicine

Summaries for Patients

Aspirin to Prevent Preeclampsia-Related Complications and
Death: U.S. Preventive Services Task Force Recommendation
Statement

The full report is titled

Low-Dose Aspirin Use for the
Prevention of Morbidity and
Mortality From Preeclampsia:
U.S. Preventive Services Task
Force Recommendation
Statement. It is in the
2 December 2014 issue of Annals
of Internal Medicine (volume 161,
pages 819-826). The author is
M.L. LeFevre, on behalf of the
U.S. Preventive Services Task
Force.

Who developed these guidelines?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that
reviews published research and makes recommendations about preventive health care.
What is the problem and what is known about it so far?
Preeclampsia is one of the most serious health problems that can affect pregnant women.
In preeclampsia, women typically develop high blood pressure and kidney problems that
can lead to high protein levels in the urine, low numbers of platelets (the blood cells that
help with clotting), liver problems, kidney failure, accumulation of fluid in the lungs,
visual disturbances, and neurologic symptoms. Preeclampsia can lead to health problems
and death in both the mother and baby. About 15% of preterm births in the United States
are due to preeclampsia.
Women are at higher risk for preeclampsia if previous pregnancies have been
complicated by preeclampsia, preterm delivery, low birthweight, stillbirth, or placental
abruption. Women with type 1 or type 2 diabetes, chronic high blood pressure, kidney
disease, or autoimmune diseases, and those who are pregnant with more than 1 baby are
also at high risk for preeclampsia.
Unfortunately, there are currently no tests that can identify women at risk for
preeclampsia. Doctors have to rely on history to evaluate risk.
Because preeclampsia can lead to serious health problems or death in the mother and
baby, there is great interest in strategies to prevent it or its complications. Taking daily
low-dose aspirin is believed to be one such preventive strategy. However, aspirin is
associated with side effects, such as bleeding. The USPSTF evaluated the benefits and
harms of using low-dose aspirin to prevent complications and death due to preeclampsia to
determine whether it could recommend its use in pregnant women at increased risk.
How did the USPSTF develop these recommendations?
The USPSTF reviewed available evidence on the benefits and harms of using low-dose
aspirin to prevent preeclampsia and its complications in women at increased risk.

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What did the authors find?

The USPSTF found evidence that low-dose aspirin (ranging from 60 to 150 mg daily)
given to women at risk for preeclampsia reduced their risk for preeclampsia by 24%, for
preterm birth by 14%, and for low birthweight by 20%. There is also adequate evidence
that low-dose aspirin does not increase the risk for placental abruption or serious bleeding
in mother or baby. One study followed babies whose mothers had used low-dose aspirin
during pregnancy up to age 18 months and found no developmental harms associated with
its use.
What does the USPSTF recommend that patients and doctors do?
Pregnant women who are at increased risk for preeclampsia and have no history of allergy
or other adverse effects from aspirin should take 81 mg of aspirin daily beginning after the
12th week of pregnancy.
What are the cautions related to these recommendations?
This recommendation does not apply to women who do not have risk factors for
preeclampsia.

This article was published online first at www.annals.org on 9 September 2014.

Ann Intern Med. 2014;161:I-28. doi:10.7326/P14-9041

I-28 2014 American College of Physicians

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