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Universal vs risk-based aspirin prophylaxis in pregnancy: Time for a paradigm shift?
Maura Jones Pullins1, Kim Boggess1
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
None:
Low-dose aspirin is an evidence-based intervention that reduces the risk of preeclampsia and related maternal morbidity. Current U.S. guidelines recommend a risk-based approach, targeting individuals at high or moderate risk. However, implementation remains inconsistent, and risk stratification may fail to identify a substantial proportion of patients who ultimately develop preeclampsia. This paper evaluates the evidence supporting low-dose aspirin, the limitations of current risk-based strategies, and the potential benefits and harms of a universal prophylaxis approach. We argue that universal aspirin prophylaxis offers advantages in simplicity, equity, and implementation.
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