From the Guidelines
Women with moderate risk factors for preeclampsia, such as nulliparity, age over 35 years, BMI greater than 30, family history of preeclampsia, and pregnancy interval greater than 10 years, should receive regular prenatal monitoring and consider low-dose aspirin (100-150 mg daily) starting from 12 weeks of gestation, as recommended by the most recent guidelines 1.
Moderate Risk Factors for Preeclampsia
Moderate risk factors for preeclampsia include:
- Nulliparity (first pregnancy)
- Age over 35 years
- BMI greater than 30
- Family history of preeclampsia
- Pregnancy interval greater than 10 years
- Multiple gestation (twins, triplets)
- Certain medical conditions like chronic hypertension, type 1 or 2 diabetes, and renal disease These factors increase a woman's risk of developing preeclampsia but to a lesser degree than high-risk factors such as previous preeclampsia or autoimmune disorders.
Recommendations for Moderate Risk Factors
The most recent guidelines recommend that women with moderate risk factors for preeclampsia should receive regular prenatal monitoring of blood pressure, urine protein levels, and fetal growth 1. Additionally, low-dose aspirin (100-150 mg daily) starting from 12 weeks of gestation may be beneficial for women with multiple moderate risk factors, as it has been shown to reduce the risk of preeclampsia, preterm birth, and intrauterine growth restriction (IUGR) 1.
Pathophysiology and Prevention
The pathophysiology behind these risk factors relates to their potential to cause placental dysfunction, maternal vascular endothelial damage, or systemic inflammatory responses that contribute to the development of preeclampsia 1. Early identification of these risk factors allows for appropriate surveillance and timely intervention to improve maternal and fetal outcomes. Low-dose aspirin has been proposed to decrease the risk of preeclampsia through inhibition of cyclooxygenase-1 in the arachidonic acid pathway, decreasing thromboxane A2 production 1.
From the Research
Moderate Risk Factors for Preeclampsia
The following are considered moderate risk factors for preeclampsia:
- First pregnancy 2
- Maternal age of 35 years or older 2
- A body mass index greater than 30 2
- Family history of preeclampsia 2
- Sociodemographic characteristics 2
- Personal history factors 2
Low-Dose Aspirin Prophylaxis for Moderate Risk Factors
Low-dose aspirin prophylaxis should be considered for women with more than one of several moderate risk factors for preeclampsia 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 2.
Implementation of Low-Dose Aspirin Prophylaxis
Despite recommendations, low-dose aspirin use is reported in <50% of patients with high-risk factors and <25% of patients with >1 moderate-risk factor 3. Checklists can be used to reduce the chance that risk factors might be inadvertently overlooked and to improve the probability of aspirin being recommended for all appropriate candidates 4.
Adherence to Aspirin Recommendation
Among the participants who recalled aspirin recommendation, adherence was similar between high-risk and moderate-risk groups 5. Patients with chronic hypertension, a history of preeclampsia or gestational hypertension in a previous pregnancy, and pregestational diabetes mellitus were most likely to report receiving aspirin recommendation 5. Nonadherent patients rarely discussed their decision with their medical provider 5.