A $0.03 Pill That Could Save Maternal Lives: An Update on the State of Low-Dose Aspirin for Preeclampsia Prevention- part 1

Preeclampsia is the second leading cause of maternal mortality worldwide, complicating roughly 4% of all pregnancies in the United States, and accounting for 6% of all preterm births. It can cause seizures, stroke, liver failure, and even death. For women at high risk, a small, over-the-counter pill can offer evidence-based protection.

Low-dose aspirin (LDA) is the only currently known preventative therapy for pre-eclampsia. Yet, so many high-risk pregnant women who could benefit from LDA are still not taking it despite the medical evidence in support of its benefits.

What does the latest U.S. evidence show?

The U.S. Preventive Services Task Force (USPSTF) issued a “Grade B recommendation” in 2021, reaffirming its 2014 guidance that daily low-dose aspirin (81 mg/day) should be initiated after 12 weeks of gestation in those at high risk for preeclampsia. Under the Affordable Care Act, a Grade B recommendation means insurers are required to cover LDA for eligible patients.

High-risk individuals are those with a prior history of preeclampsia, chronic hypertension,
pregestational diabetes, pregnancy with multiples, kidney disease, and autoimmune conditions. The USPSTF's evidence review confirmed substantial overall benefit with no statistically significant increase in risk of placental abruption, postpartum hemorrhage, or miscarriage.

By Brittany de Soto Palmer