March 22, 2021
National Center for Health Research’s Comments on the U.S. Preventive Services Task Force Draft Recommendation Statement on Aspirin Use to Prevent Morbidity and Mortality from Preeclampsia
We are writing to express our views on the U.S. Preventive Services Task Force (USPSTF) draft recommendation statement regarding low-dose aspirin use to reduce the risk of preeclampsia, preterm birth, small gestational age/intrauterine growth restriction (SGA/IUGR), and perinatal mortality in pregnant patients at high risk for preeclampsia.
The National Center for Health Research (NCHR) is a nonprofit think tank that conducts, analyzes, and scrutinizes research on a range of health issues, with particular focus on which prevention strategies and treatments are most effective for which patients and consumers. We do not accept funding from companies that make products that are the subject of our work, so we have no conflicts of interest.
We support this update, strengthened by new evidence, maintaining the 2014 “B” recommendation that there is moderate certainty of a substantial net benefit for the use of low-dose aspirin as preventive medication after 12 weeks of gestation in women who are at high risk for preeclampsia. However, most data USPSTF reviewed are from trials comprised predominantly of White and younger women. Since Black women are at a greater risk for both maternal and infant morbidity and perinatal mortality, and since women of advanced maternal age are at a greater risk of preeclampsia, we strongly agree with the USPSTF’s assertion that trials must recruit more people from the populations that carry the greatest disease burden. Since risks and benefits can vary for these different groups, the goal of greater diversity should be for there to be enough women in each subgroup for analyses to determine if the benefits are likely to outweigh the risks for that specific group. In other words, each subgroup analysis should determine if benefits outweigh risks for older women, Black women, for Hispanic women, and for Asian women or women from other minority groups.
Further, we agree with the USPSTF’s recommendation that further research is necessary to determine which population groups are most likely to benefit from the prophylactic use of aspirin, what the risk factors are, and what dosage and timing is likely to have the greatest benefit.