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Observational Study
. 2025 Jul 1;8(7):e2521792.
doi: 10.1001/jamanetworkopen.2025.21792.

Utility of the US Preventive Services Task Force for Preeclampsia Risk Assessment and Aspirin Prophylaxis

Thomas F McElrath  1   2   3 , Arun Jeyabalan  4   5 , Arkady Khodursky  3 , Alison B Moe  3 , Manfred Lee  3 , Maneesh Jain  3 , Laura Goetzl  6 , Elizabeth F Sutton  7 , Pamela M Simmons  7 , George R Saade  8 , Antonio Saad  9 , Luis D Pacheco  10 , Esther Park-Hwang  11 , Antonina I Frolova  12 , Ebony B Carter  13 , Ai-Ris Y Collier  2   14 , Daniel G Kiefer  15 , Vincenzo Berghella  16 , Rupsa C Boelig  16 , Michal A Elovitz  17 , Cynthia Gyamfi-Bannerman  18   19 , Joseph R Biggio  20 , Kara Rood  21 , William A Grobman  22 , Carrie Haverty  3 , Morten Rasmussen  3
Affiliations
Observational Study

Utility of the US Preventive Services Task Force for Preeclampsia Risk Assessment and Aspirin Prophylaxis

Thomas F McElrath et al. JAMA Netw Open. .

Erratum in

  • Errors in Abstract, Results, and Tables.
    [No authors listed] [No authors listed] JAMA Netw Open. 2025 Aug 1;8(8):e2530317. doi: 10.1001/jamanetworkopen.2025.30317. JAMA Netw Open. 2025. PMID: 40788652 Free PMC article. No abstract available.

Abstract

Importance: The US Preventive Services Task Force (USPSTF) guidelines on preeclampsia risk assessment and aspirin prophylaxis (AP) have not been evaluated for clinical utility.

Objective: To evaluate which characteristics in the USPSTF guidelines identify risk status and the association of preeclampsia risk with AP recommendations.

Design, setting, and participants: This observational cohort study enrolled from July 2020 to March 2023 with data analysis performed from October to December 2024. Enrollment occurred at 11 centers throughout the US or via direct-to-participant recruitment. Pregnant participants aged 18 years or older with a singleton pregnancy less than 22 weeks' gestation were selected via convenience sampling.

Exposure: The exposures were clinical factors abstracted from medical records by research coordinators, which were stratified according to USPSTF definitions of low, moderate (parity, advanced maternal age [AMA], race, and body mass index), and high (chronic hypertension, prior preeclampsia, type 1 or 2 diabetes, kidney disease, and/or autoimmune conditions) risk.

Main outcomes and measures: Data collected included AP recommendation, presence of USPSTF-defined moderate risk factors or high risk factors, and any preeclampsia diagnosis. Effect sizes and relative risk (RR) were calculated within risk strata.

Results: Of 5684 participants (median [IQR] age, 30.9 [26.4-34.6] years; 267 [4.1%] Asian; 1191 [21.0%] Black; 990 Hispanic [17.4%]; 2764 [48.6%] White; and 472 [8.3%] with other race or ethnicity), 5046 (88.8%) were at increased risk of preeclampsia (3996 [70.3%] at moderate risk and 1050 [18.5%] at high risk). A total of 2438 participants (43.1%) received an AP recommendation. The overall preeclampsia rate was 12.1% (685 participants). The PE rates specific to USPSTF categories were 3.0% for those at low risk (19 of 638 participants), 10.5% for those at moderate risk (419 of 3996 patients), and 23.5% for those at high risk (247 of 1050 participants). Among individuals with 2 or more moderate risk factors but without any high risk factor, nulliparity was associated with significantly increased risk of preeclampsia (RR, 1.48; 95% CI, 1.35-1.62; P < .001), while AMA was associated with decreased risk (RR, 0.79; 95% CI, 0.65-0.96; P = .02); there was no association with obesity (RR, 1.11; 95% CI, 1.01-1.22; P = .048) or Black race (RR, 0.95; 95% CI, 0.80-1.14; P = .63). Of 1044 participants with any high risk factors, 856 (82.0%) were recommended AP and of 634 at low risk, 538 (85.9%) were not recommended AP. In contrast, of 1942 participants with 1 moderate risk factor, 463 (23.8%) were recommended AP, and of 2032 with 2 or more moderate risk factors, 1024 (50.4%) were recommended AP.

Conclusions and relevance: In this prospective cohort study of 5684 singleton pregnancies, 89% of the population was assessed as having increased risk (moderate or high) of preeclampsia by USPSTF criteria. These findings suggest that moderate risk factors in the absence of high risk factors show no or low value for estimating the risk of developing preeclampsia, leading to nonspecific recommendations of AP in the moderate risk category.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr McElrath reported receiving grants from the National Institutes of Health, personal fees from UpToDate (author) and Hoffman-LaRoache (scientific advisory board) outside the submitted work. Dr Khodursky reported having a pending application for a patent (US application No. 18/167,322; international application No. PCT/ US2024/027,444 ) outside the submitted work. Dr Jain reported holding a US patent (patent No. 11,208,693) and having a pending patent (US application No. 18/167,322; International application No. US 2024/027,444) outside the submitted work. Dr Park-Hwang reported receiving grants from Multicare Health System outside the submitted work. Dr Collier reported receiving grants from the Massachusetts Consortium on Pathogen Readiness, William F. Milton Fund (Harvard University), National Institute of Allergy and Infectious Diseases of the National Institutes of Health (No. R21 AI169309), Centers for Disease Control and Prevention (No. U01 IP001257), Sanofi (clinical research contract), Hookipa (clinical research contract), and Imunon (laboratory and clinical research contract) outside the submitted work. Dr Boelig reported receiving grants from the National Institutes of Health (primary investigator of grant relating to aspirin and preeclampsia or preterm birth), March of Dimes (primary investigator of grant relating to aspirin and preeclampsia or preterm birth), and Covis Pharma (primary investigator of a grant relating to intravenous iron for maternal anemia) outside the submitted work. Dr Elovitz reported receiving personal fees from Mirvie outside the submitted work. Dr Biggio reported receiving grants from Sera Prognostics outside the submitted work. Dr Rasmussen reported holding a patent (No. 11,208,693), and having a patent pending (US Application No. 18/167,322; International Application No PCT/ US2024/027,444) outside the submitted work. Drs McElrath, Khodurksy, Moe, Lee, Jain, and Rasmussen and Mrs Haverty report being employees and shareholders of Mirvie Inc, and Dr Goetzl reports serving on a clinical outcome review board for Mirvie Inc. Drs Jeyabalan, Collier, Boelig, Gyamfi-Bannerman, Biggio, and Grobman reported receiving grants from Mirvie Inc during the conduct of the study, and Drs Sutton and Elovitz reported receiving personal fees from Mirvie during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Preeclampsia (PE) Diagnoses, Aspirin Prophylaxis (AP) Recommendation, and Relative Risk for Preeclampsia Due to Moderate Risk Factors in Exclusive Risk Categories
The high risk category includes those with at least 1 high risk factor: prior PE, chronic hypertension, type 1 or 2 diabetes, kidney disease, and/or autoimmune disease. The moderate risk category includes those with body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 30 or greater, advanced maternal age (AMA; 35 years or older at estimated due date), Black race, and/or nulliparity. The moderate 1 risk category includes those with 1 and only 1 of these moderate risk factors and the moderate 2+ risk category includes those with 2 or more moderate risk factors and no high risk factors. aBlack race, due to social, rather than biological factors
See this image and copyright information in PMC

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