Consensus Statement: Screening for Early-Onset Preeclampsia and Aspirin Prophylaxis in the US image

Consensus Statement: Screening for Early-Onset Preeclampsia and Aspirin Prophylaxis in the US


Under the auspices of the Gottesfeld-Hohler Memorial Foundation, a Consensus Statement was developed to address the multiple guidelines regarding screening for early-onset preeclampsia (open access summaries of these recommendations can be found below in ‘Related ObG Topics’). This ‘Think Tank Summary’ was comprised of expert participants, including representatives from ACOG, NICHD, SMFM, AIUM, FMF and ISUOG. The Consensus Statement recognizes that while there are differences regarding approach, there is consensus regarding the importance of screening and use of prophylactic aspirin when appropriate. The authors conclude with the following

…it is strongly advised to identify patients at high risk for preeclampsia at least by the guidelines of ACOG, SMFM, the U.S. Preventative Services Task Force, or the Fetal Medicine Foundation criteria.

Offering prophylactic low-dose aspirin starting in the late first or early second trimester, and close scrutiny of these women throughout pregnancy, may help to avert or mitigate the severe complications for the mother, fetus, and neonate that can result from preeclampsia.


Summary of Professional Recommendations

    • Recommend screening for preeclampsia using personal and family history risk factors
    • Support the use of low-dose aspirin (81 mg), optimally beginning early in pregnancy <16 weeks (per ACOG)
  • FMF (aligned with ISUOG and FIGO recommendations)
    • Based on results from the ASPRE trial (see summary below in ‘Related ObG Topics’), these organizations recommend combined screening
    • The early-preeclampsia screening algorithm includes
      • Maternal factors (history, demographics, CVD and metabolic profile)
      • Maternal arterial BP (MAP)
      • Placental growth factor (PlGF)
      • Pulsatility index (PI) to assess uterine artery resistance
    • For women at high risk, aspirin should be started early in pregnancy
      • Ideally between 11w0d and 14w6d
      • 150 mg every night until 36 weeks, delivery or preeclampsia is diagnosed
  • Several studies have duplicated the success of ASPRE regarding test performance
    • However, the Consensus Statement points out that some other investigators have not demonstrated similar results
    • “Reason for the discrepancy is unclear” but could be due to different populations and/or quality of MAP and ultrasound technique

Review of Aspirin Data

  • The Consensus Statement provides a literature review of prophylactic aspirin for the prevention of preeclampsia
  • Prophylactic aspirin impacts early-onset and not term preeclampsia
  • ASPRE study outcome was preeclampsia diagnosis <37 weeks
    • The study did not show an overall difference in rates of preeclampsia but rather preeclampsia that led to delivery <37 weeks
    • The above may explain those studies that could not duplicate ASPRE performance | Delivery protocols and standards can vary by region
  • Dosing
    • The Consensus Statement recognizes data to support aspirin doses >100 mg
    • Higher dose does not appear to increase maternal risk
    • Data regarding potential fetal/newborn risks related to altered platelet function are ‘limited’  
  • Universal aspirin prophylaxis
    • There has been literature suggesting that universal aspirin prophylaxis is the most cost-effective strategy (for study review, see ‘Related ObG Topics’ below)
    • Data limited
      • Results are based on modeling and not ‘real world’ usage
      • Complications that would occur in approximately 4 million pregnancies is unknown (although authors acknowledge maternal safety for low-dose aspirin)
      • Compliance rates are not known
    • The Consensus Statement calls for further trials

Implementation Considerations

  • The Consensus Statement recognizes that the FMF model may detect >80% of early-onset preeclampsia
  • However, hurdles related to US implementation include
    • Addition of new expenses
    • Training and availability of sonologists with appropriate skill set for assessment of uterine artery PI
  • Aspirin dose
    • “Uncertainty remains regarding optimal dosage (81 vs 162 vs 150)”

Learn More – Primary Sources:

Gottesfeld-Hohler Memorial Foundation Risk Assessment for Early-Onset Preeclampsia in the United States: Think Tank Summary