Preeclampsia, a multisystem inflammatory syndrome characterized by hypertension and proteinuria in the second half of pregnancy, is a leading cause of maternal and infant morbidity and mortality. In the absence of validated biomarkers and clinical diagnostic tests, clinicians rely mostly on medical history to identify women at high risk. The U.S. Preventive Services Task Force (USPSTF) reviewed evidence from clinical trials to evaluate the incidence of preeclampsia and the maternal and perinatal benefits related to low-dose aspirin in women at high risk.

In 1996 the USPSTF found insufficient evidence to recommend low-dose aspirin to prevent preeclampsia. The USPSTF's updated review, which incorporates more recent evidence, found that low-dose aspirin (60 to 150 mg per day) started between 12 and 28 weeks into pregnancy has a substantial benefit in women at high risk for preeclampsia. According to the review, low-dose aspirin reduced the risk of preeclampsia by 24%, of preterm birth by 14%, and of intrauterine growth restriction by 20%. Moreover, prophylactic aspirin didn't increase the risks of placental abruption, postpartum hemorrhage, fetal intracranial bleeding, or perinatal death. Although the research on long-term outcomes in infants exposed to aspirin in utero is limited, no developmental harms were identified.

The USPSTF recommends the use of low-dose aspirin in asymptomatic pregnant women who are at increased risk for preeclampsia and have no history of adverse effects from or contraindications to low-dose aspirin. Although the daily dosages used in the studies ranged from 60 to 150 mg, according to the task force, 81 mg-a dose that's readily available in tablet form in the United States because of its prophylactic use in patients with heart disease-is a reasonable daily dosage for the prevention of preeclampsia.

The USPSTF statement outlines a pragmatic approach to assessing the risk of preeclampsia and recommends that clinicians discuss the benefits and harms of low-dose aspirin use with their patients.

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