A primigravida at 12 weeks gestation is identified as high-risk for pre-eclampsia based on uterine artery Doppler pulsatility index, PAPP-A, and mean arterial pressure. What is the MOST evidence-based intervention to reduce her risk of early-onset pre-eclampsia?

• A Low molecular weight heparin starting at 12 weeks
• B Low-dose aspirin (150 mg/day) started before 16 weeks gestation ✓
• C Calcium supplementation 1.5–2 g/day starting at 20 weeks
• D Progesterone 200 mg vaginally per day from 12–34 weeks

Explanation

Low-dose aspirin (100–150 mg/day) initiated before 16 weeks gestation is the most evidence-based intervention for high-risk women identified by first-trimester combined screening (the ASPRE trial, 2017). In the ASPRE trial, aspirin 150 mg at bedtime reduced early-onset pre-eclampsia (<34 weeks) by 62% in the high-risk group. The Fetal Medicine Foundation algorithm using uterine artery Doppler, PAPP-A, MAP, and PlGF identifies this cohort. Calcium reduces late-onset pre-eclampsia in low-calcium populations but is not a first-line preventive tool for early-onset disease in aspirin's context.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.