Is Aspirin (Acetylsalicylic Acid) indicated for patients with a history of post-pregnancy preeclampsia?

Low-Dose Aspirin for Prevention of Preeclampsia in Patients with History of Post-Pregnancy Preeclampsia

Low-dose aspirin is strongly recommended for patients with a history of preeclampsia, including those with post-pregnancy preeclampsia, to prevent recurrence in subsequent pregnancies. 1, 2

Indications for Aspirin Prophylaxis

• Low-dose aspirin is indicated for women with a history of preeclampsia, especially those with early-onset preeclampsia with delivery before 34 weeks of gestation 3, 4
• History of preeclampsia is considered a high-risk factor that warrants prophylactic aspirin therapy in subsequent pregnancies 5, 1
• Women with both chronic hypertension and history of preeclampsia have a significantly higher risk of developing superimposed preeclampsia in subsequent pregnancies (45.7% vs. 30.1% in those with chronic hypertension alone) 5

Dosage and Timing Recommendations

• The recommended dose is 81 mg/day for most high-risk women 2, 4
• For women with diabetes or higher BMI (>40 kg/m²), a higher dose of 100-150 mg/day may be more effective 1, 6
• Aspirin should be initiated between 12 and 16 weeks of gestation (optimally before 16 weeks) and continued daily until delivery 3, 4
• Starting treatment before 16 weeks of gestation provides greater reduction in preeclampsia risk compared to later initiation 7, 6

Clinical Benefits

• Low-dose aspirin reduces the risk of preeclampsia by 24% in high-risk women 2
• The number needed to treat to prevent one case of preeclampsia is 42 in women at increased risk 2
• Additional benefits include:
  • 14% reduction in risk of preterm birth 2
  • 20% reduction in risk of intrauterine growth restriction 2
  • Increase in mean birthweight by approximately 130g 2

Safety Profile

• Low-dose aspirin during pregnancy is considered safe with a low likelihood of serious maternal or fetal complications 3, 4
• No increased risk of placental abruption, postpartum hemorrhage, fetal intracranial bleeding, or perinatal mortality 2
• No significant differences in cesarean delivery rates between aspirin and placebo groups 2

Important Clinical Considerations

• Aspirin appears most effective for preventing preterm preeclampsia rather than term preeclampsia 6
• Patient compliance and weight are important variables affecting treatment success 6
• Despite aspirin therapy, some women still develop preeclampsia, possibly due to mechanisms not affected by aspirin 6
• The effectiveness of aspirin may be limited in patients with chronic hypertension, kidney disease, or diabetes mellitus as the sole risk factor 7

Guideline Recommendations

• The American College of Obstetricians and Gynecologists recommends low-dose aspirin for women with a history of preeclampsia, especially early-onset preeclampsia 3, 4
• The U.S. Preventive Services Task Force recommends low-dose aspirin for women at high risk of preeclampsia, including those with a history of preeclampsia 5
• The World Health Organization recommends low-dose aspirin (75 mg/day) for high-risk women, including those with a history of preeclampsia 5
• The American Heart Association and American Stroke Association recommend low-dose aspirin for women with previous pregnancy-related hypertension 5