What is the appropriate prenatal care for a 36-year-old woman, gravida (number of times pregnant) 2, para (number of viable births) 1, with a history of preeclampsia (high blood pressure during pregnancy) without severe features, presenting at 9 weeks gestation with normal blood pressure (euglycemia and normotension) and a body mass index (BMI) of 23 kg/m2?

From the Guidelines

For this 36-year-old woman at 9 weeks gestation with a history of preeclampsia in her previous pregnancy, I recommend low-dose aspirin (81 mg daily) starting now and continuing until delivery. This preventive therapy should be initiated because her history of preeclampsia in a previous pregnancy places her at increased risk for recurrence, as noted in the USPSTF recommendation statement 1. Low-dose aspirin has been shown to reduce the risk of preeclampsia by approximately 15-25% in high-risk women when started before 16 weeks gestation. The medication works by improving the balance between thromboxane and prostacyclin, promoting better placental development and reducing systemic inflammation.

The patient should take the aspirin daily with food to minimize gastrointestinal side effects. In addition to aspirin prophylaxis, she should receive standard prenatal care including more frequent blood pressure monitoring throughout pregnancy, as recommended by the USPSTF 1. Despite her normal blood pressure and healthy BMI currently, her history makes preeclampsia prevention an important focus of her prenatal care. The medication is generally well-tolerated and the benefits outweigh the minimal risks in women with her risk profile. It is also important to note that the ISSHP classification, diagnosis, and management recommendations for international practice suggest that women with a history of preeclampsia should be closely monitored for the development of severe hypertension and other complications 1.

Key aspects of her care will include:

• Regular blood pressure monitoring
• Urinalysis and urine culture to assess for proteinuria and other complications
• Fetal monitoring to assess for fetal growth restriction and other complications
• Close monitoring for signs and symptoms of severe preeclampsia, such as severe hypertension, neurological signs or symptoms, and pulmonary edema. The patient's history of preeclampsia without severe features in her previous pregnancy does not necessarily indicate a higher risk of severe complications in this pregnancy, but close monitoring and preventive measures can help reduce the risk of recurrence and improve outcomes for both the mother and the fetus.

From the Research

Preeclampsia Risk Factors and Diagnosis

• The patient's history of preeclampsia without severe features in her first pregnancy is a significant risk factor for developing preeclampsia in subsequent pregnancies, as shown in a study published in 2025 2.
• The study found that approximately 20% of patients with initial preeclampsia experience recurrence, and the timing of onset in the primary pregnancy is an important predictive factor for preeclampsia in subsequent pregnancies.
• Another study published in 2024 found that new-onset proteinuria is still the main parameter for identifying preeclampsia, and the interval between increased blood pressure and proteinuria is probably related to the imbalance in the sFlt-1/VEGF ratio 3.

Proteinuria and Urine Tests

• A study published in 2017 found that spot urine protein measurements can be used to characterize the changes in protein-to-creatinine ratios in normotensive pregnancies, as well as identify clinical characteristics associated with isolated proteinuria and preeclampsia 4.
• The study found that women who develop isolated proteinuria at delivery have a larger increase in blood pressure than women without proteinuria and have a "microalbuminuric" phase earlier in gestation.
• The patient's prenatal laboratory tests, including urinalysis and urine culture, are essential for monitoring proteinuria and detecting any potential complications early on.

Blood Pressure Monitoring

• The patient's blood pressure is currently within a normal range, but close monitoring is necessary due to her history of preeclampsia.
• A study published in 2025 found that changes in mean arterial pressure (MAP) may be useful indicators for predicting preeclampsia, particularly in patients with a history of the condition 2.
• Regular blood pressure checks and monitoring of proteinuria will help identify any potential issues early on and ensure the best possible outcome for the patient and her baby.