April 8, 2014 — The U.S. Preventive Services Task Force in a draft recommendation issued Monday said that pregnant women at high risk of developing pre-eclampsia should take a daily low-dose aspirin to reduce their risk of developing the condition, the New York Times' "Well" reports (Saint Louis, "Well," New York Times, 4/7).
Pre-eclampsia -- characterized by high blood pressure, protein in the urine and fluid retention -- affects about 4% of pregnant women in the U.S., according to the Wall Street Journal. It can be managed through drugs and other medical therapies (Burton, Wall Street Journal, 4/7). However, the only way to end the condition is for the woman to give birth ("Well," New York Times, 4/7). The condition can lead to preterm birth and progress into eclampsia, which can result in seizures or coma.
The draft guidance from USPSTF comes after the American College of Obstetricians and Gynecologists released similar recommendations last fall. USPSTF previously said that there was not evidence to decide whether aspirin therapy should be recommended. Normally, pregnant women are advised to avoid aspirin because of the risk of maternal and fetal bleeding (Wall Street Journal, 4/7).
USPSTF reviewed 23 studies in which women at a high risk for developing pre-eclampsia took low-dose aspirin. The panel found that such treatment reduced the risk of pre-eclampsia by 24%, reduced the risk of intrauterine growth restriction by 20% and reduced the risk of preterm birth by 14%.
According to the review, "No harms were identified, but long-term evidence was limited" (Wickline, MedPage Today, 4/7).
The panel recommended that women at a high risk for pre-eclampsia take an 81 milligram dose of aspirin daily after 12 weeks gestation. According to the guidance, women at a high risk for the condition include those who have had pre-eclampsia during a prior pregnancy, particularly if the pregnancy was preterm; women carrying more than one fetus; and women who had diabetes or high blood pressure at conception.
In addition, the guidance recommended that pregnant women with multiple moderate-risk factors consider taking low-dose aspirin as well. Moderate risks include obesity, a family history of pre-eclampsia, being African-American and being older than age 35.
Michael LeFevre, chair of the panel and a professor of family medicine at the University of Missouri, said that while any single high-risk factor is grounds to take the aspirin regimen, "it's a judgment call between physicians and patients as to whether a combination of moderate-risk factors is enough to justify taking low-dose aspirin" ("Well," New York Times, 4/7).
USPSTF is seeking public comment before finalizing the guidance (Wall Street Journal, 4/7).
James Martin of the University of Mississippi Medical Center, a former president of ACOG, praised the recommendations, saying that they "are exactly consistent" with those issued by ACOG.
Vincenzo Berghella, president of the Society for Maternal-Fetal Medicine, said that while the guidance is good, "the clinical issue goes farther." Berghella added, "Here, they say that daily low-dose aspirin prevents clinically important outcomes. [But] the issue is who to give it to" (MedPage Today, 4/7).