title: Should we recommend universal aspirin for all pregnant women?
abstract: Low-dose aspirin has been demonstrated to reduce the incidence of preeclampsia and fetal growth restriction in at-risk populations. Its role in low-risk populations is as yet unknown. Novel preeclampsia screening tests are emerging that can predict the risk of the development of preeclampsia from as early as 11 weeks of gestation. It may be more efficacious, acceptable, and cost-effective to prescribe low-dose aspirin to all pregnant women from the first trimester as opposed to performing a screening test in the first instance. There is variation in opinion: the American College of Obstetricians and Gynecologists suggests the use of aspirin only in women who are at risk of preeclampsia, based on patient history; the National Institute for Health and Clinical Excellence, UK, and the US Preventative Services Task Force recommend the use of low-dose aspirin if there is 1 major or 2 moderate risk factors. This point-counterpoint discussion shall address (1) controversies regarding the real impact of low-dose aspirin; (2) controversies in the actual guidelines among the different national societies; (3) controversies regarding emerging preeclampsia screening tests in terms of cost-effectiveness and efficacy, and (4) points in favor of the provision of universal vs screened-positive women.
authors.affiliation: Department of Fetal Medicine, National Maternity Hospital, Dublin, Ireland.
authors.forename: Fionnuala
authors.initials: F
authors.lastname: Mone
authors.affiliation: Department of Fetal Medicine, National Maternity Hospital, Dublin, Ireland.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Mulcahy
authors.affiliation: Department of Fetal Medicine, National Maternity Hospital, Dublin, Ireland; UCD Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.
authors.forename: Peter
authors.initials: P
authors.lastname: McParland
authors.affiliation: Department of Fetal Medicine, National Maternity Hospital, Dublin, Ireland; UCD Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland. Electronic address: Fionnuala.mcauliffe@ucd.ie.
authors.forename: Fionnuala M
authors.initials: FM
authors.lastname: McAuliffe
mesh_terms: D001241:Aspirin / Q000627:therapeutic use*; D001794:Blood Pressure; D004351:Drug Resistance; D005260:Female; D005317:Fetal Growth Retardation / Q000517:prevention & control*; D006801:Humans; D055118:Medication Adherence; D010342:Patient Acceptance of Health Care; D000072483:Placenta Growth Factor / Q000378:metabolism; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011225:Pre-Eclampsia / Q000378:metabolism / Q000517:prevention & control*; D011247:Pregnancy; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism; D011673:Pulsatile Flow; D018570:Risk Assessment; D055988:Uterine Artery / Q000000981:diagnostic imaging
chemical_list: D010975:Platelet Aggregation Inhibitors; D000072483:Placenta Growth Factor; D011266:Pregnancy-Associated Plasma Protein-A; D001241:Aspirin
keywords: fetal growth restriction; low-dose aspirin; preeclampsia; universal