Also, the criteria used to define “high risk” for preeclampsia varied by study, so it’s unclear which groups of women would benefit most from aspirin use during pregnancy. Finally, there is a lack of high-quality data on the effects of aspirin use during pregnancy on long-term outcomes in children. Despite these caveats, the cumulative evidence strongly points to greater benefit than harm.
CHALLENGES TO IMPLEMENTATION
You need to determine which patients are at highest risk
The principle challenge lies in the identification of patients who are at high risk for preeclampsia and thus will likely benefit from this intervention. This systematic review and meta-analysis used a large variety of risk factors to determine whether a woman was at high risk. A 2013 American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy report defined as high risk women with a history of preeclampsia in more than one previous pregnancy or women with a previous preterm delivery due to preeclampsia.4
The updated USPSTF recommendation suggests that women be considered high risk if they have any of the following: previous preeclampsia, multifetal gestation, chronic hypertension, diabetes, renal disease, or autoimmune disease.9 We consider both sets of criteria reasonable for identifying women who may benefit from low-dose aspirin during pregnancy.
REFERENCES
1. Henderson J, Whitlock E, O’Connor E, et al. Low-dose aspirin for prevention of morbidity and mortality from preeclampsia: a systematic evidence review for the US Preventive Services Task Force. Ann Intern Med. 2014;160:695-703.
2. Ghulmiyyah L, Sibai B. Maternal mortality from preeclampsia/eclampsia. Semin Perinatol. 2012;36:56-59.
3. Ananth CV, Keyes KM, Wapner RJ. Pre-eclampsia rates in the United States, 1980-2010: age-period-cohort analysis. BMJ. 2013;347:f6564.
4. American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Obstet Gynecol. 2013;122:1122-1131.
5. Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ. 2005; 330:565.
6. US Preventive Services Task Force. Aspirin prophylaxis in pregnancy. In: Guide to Clinical Preventive Services: Report of the US Preventive Services Task Force. 2nd ed. Washington, DC: US Department of Health and Human Services; 1996.
7. Duley L, Henderson-Smart DJ, Meher S, et al. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev. 2007(2):CD004659. 8. Askie LM, Duley L, Henderson-Smart DJ, et al; PARIS Collaborative Group. Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. Lancet. 2007;369: 1791-1798. 9. LeFevre ML; US Preventive Services Task Force. Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia [recommendation statement]. Ann Intern Med. 2014;161:819-826.
ACKNOWLEDGEMENT
The PURLs Surveillance System was supported in part by Grant Number UL1RR024999 from the National Center For Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center For Research Resources or the National Institutes of Health.
Copyright © 2015. The Family Physicians Inquiries Network. All rights reserved.
Reprinted with permission from The Family Physicians Inquiries Network and The Journal of Family Practice. 2015;64(5):301-303.