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

Area of Science:

• Reproductive Medicine
• Obstetrics
• Maternal-Fetal Medicine

Background:

• Preeclampsia affects 8% of pregnancies, contributing significantly to maternal and neonatal morbidity/mortality.
• Hypertensive disorders of pregnancy have doubled in the US since 2007, coinciding with rising maternal mortality rates.
• Effective risk stratification tools are needed for preeclampsia prevention and treatment.

Purpose of the Study:

• To assess the distribution of risk categories (low, moderate, high) for preeclampsia using USPSTF criteria in a diverse population.
• To evaluate the association between USPSTF risk factors and preeclampsia incidence.
• To examine the initiation of aspirin prophylaxis (AP) recommendations based on risk stratification.

Main Methods:

• Prospective cohort study involving 5684 participants across 11 US medical centers and social media recruitment.
• Participants (≥18 years, singleton pregnancy, enrolled <22 weeks gestation) were classified by USPSTF criteria.
• Primary outcome: preeclampsia. Effect modification: AP recommendation.

Main Results:

• 18.5% were high-risk, 70.3% moderate-risk (subdivided into moderate 1 and moderate 2+), and 11.2% low-risk.
• Preeclampsia incidence was significantly increased in those with prior preeclampsia (RR 1.44) or chronic hypertension (RR 1.26).
• Approximately 47% of participants with risk factors received AP recommendations, more frequently in those with pre-existing conditions.

Conclusions:

• USPSTF criteria are associated with increased preeclampsia risk, particularly for high-risk factors.
• Moderate risk factors showed weaker associations with preeclampsia.
• Aspirin prophylaxis recommendations were initiated across high- and low-risk categories, suggesting broader application.