Which of the following statements regarding the use of low-dose aspirin for pre-eclampsia prevention in high-risk nulliparous women is correct according to the USPSTF 2021 recommendation?

• A Aspirin 81 mg daily starting at 20 weeks
• B Aspirin 325 mg daily starting at 16 weeks
• C Aspirin 150 mg daily starting at 28 weeks
• D Aspirin 81 mg daily starting at 12 weeks ✓

Explanation

The USPSTF 2021 recommendation advises initiating low-dose aspirin (81 mg daily) after 12 weeks of gestation (specifically at 12-28 weeks, ideally before 16 weeks) in high-risk women. The ASPRE trial used 150 mg, which is the standard in many international guidelines, but USPSTF and ACOG endorse 81 mg as the standard US dose. Starting at 20 weeks or 28 weeks is too late for optimal benefit, as the ASPRE trial showed aspirin started after 16 weeks had reduced efficacy.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.