Low-Dose Aspirin Use in Pregnant Patients with PCOS
Low-dose aspirin is not routinely recommended for pregnant patients with a history of PCOS alone, as PCOS is not listed among the high-risk factors for preeclampsia in the most recent ACOG Committee Opinion 743. 1, 2
Risk Factors for Preeclampsia Requiring Aspirin Prophylaxis
High-Risk Factors (any one of these warrants aspirin prophylaxis):
- History of preeclampsia 1
- Multifetal gestation 1
- Chronic hypertension 1
- Type 1 or type 2 diabetes 1
- Renal disease 1
- Autoimmune disease 1
Moderate-Risk Factors (more than one needed for aspirin prophylaxis):
- First pregnancy 1
- Maternal age ≥35 years 1
- BMI >30 kg/m² 1
- Family history of preeclampsia 1
- Sociodemographic characteristics (low socioeconomic status) 1
- Personal history factors 1
Current Guidelines on PCOS and Aspirin Use
- ACOG Committee Opinion 743 does not include PCOS as either a high-risk or moderate-risk factor for preeclampsia requiring aspirin prophylaxis 2
- The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine support the U.S. Preventive Services Task Force guideline criteria for prevention of preeclampsia, which also does not specifically list PCOS as an indication 1
- Low-dose aspirin (81 mg/day) prophylaxis is recommended only for women at high risk of preeclampsia based on established risk factors 1
Special Considerations for PCOS Patients
- If a patient with PCOS also has other high-risk factors (such as chronic hypertension, type 1 or 2 diabetes), aspirin prophylaxis would be indicated based on those factors, not the PCOS itself 3
- For PCOS patients with multiple moderate risk factors (such as first pregnancy, age ≥35, BMI >30), aspirin prophylaxis should be considered 1
- Studies specifically examining aspirin use in PCOS patients have focused on fertility outcomes rather than preeclampsia prevention 4, 5
Timing and Dosage
- When indicated, low-dose aspirin (81 mg/day) should be initiated between 12-16 weeks of gestation (optimally before 16 weeks) and continued until delivery 1
- For women with diabetes, a higher dose of 100-150 mg/day may be considered 3
Common Pitfalls to Avoid
- Prescribing aspirin for all PCOS patients without assessing other risk factors for preeclampsia 1
- Failing to identify PCOS patients who may qualify for aspirin based on other high-risk or multiple moderate-risk factors 6
- Starting aspirin prophylaxis too late (after 16 weeks), which may reduce its effectiveness 3
- Discontinuing aspirin too early before delivery 1
Implementation Challenges
- Studies show that only 57.7% of high-risk patients recall receiving aspirin recommendations, suggesting gaps in counseling or communication 6
- Patient adherence is generally good (around 80%) when recommendations are clearly communicated 6
In summary, while the OB template may suggest aspirin for patients with PCOS, this recommendation is not supported by the current ACOG Committee Opinion 743, which provides the most authoritative guidance on this topic. PCOS alone is not considered a high-risk factor for preeclampsia requiring aspirin prophylaxis.