Utility of the US Preventive Services Task Force for Preeclampsia Risk Assessment and Aspirin Prophylaxis

Area of Science:

• Obstetrics and Gynecology
• Preventive Medicine
• Clinical Epidemiology

Background:

• The US Preventive Services Task Force (USPSTF) provides guidelines for preeclampsia risk assessment and aspirin prophylaxis (AP).
• The clinical utility of these USPSTF guidelines has not been previously evaluated.
• Preeclampsia remains a significant concern in singleton pregnancies.

Purpose of the Study:

• To assess the clinical utility of USPSTF guidelines in identifying preeclampsia risk.
• To determine the association between preeclampsia risk factors and AP recommendations.

Main Methods:

• An observational cohort study included 5684 pregnant participants across 11 US centers and direct recruitment.
• Data were collected from July 2020 to March 2023, with analysis from October to December 2024.
• Participants were stratified into low, moderate, and high risk groups based on USPSTF criteria, and AP recommendations were recorded.

Main Results:

• 88.8% of participants were classified at increased risk (moderate or high) for preeclampsia.
• Preeclampsia rates were 3.0% (low risk), 10.5% (moderate risk), and 23.5% (high risk).
• Nulliparity significantly increased preeclampsia risk (RR, 1.48) in moderate-risk individuals without high-risk factors, while advanced maternal age decreased risk (RR, 0.79).

Conclusions:

• USPSTF criteria identify a large proportion of pregnancies at increased risk, but moderate risk factors alone have limited predictive value for preeclampsia.
• Current guidelines may lead to nonspecific aspirin prophylaxis recommendations in the moderate-risk category.
• Further refinement of risk stratification tools is needed for more precise preeclampsia prevention strategies.