A 35-year-old woman with pre-gestational diabetes (type 1) and chronic hypertension presents for her first antenatal visit at 10 weeks gestation. According to ACOG and ISSHP guidelines, which of the following is recommended for pre-eclampsia prevention in this patient?
- A Low-dose aspirin 75-100 mg daily starting at 12-16 weeks ✓
- B Low-dose aspirin 150 mg nightly starting at 12 weeks
- C Low-dose aspirin 81 mg daily starting at 28 weeks
- D Calcium supplementation 1.5 g daily alone, without aspirin
Correct answer: A. Low-dose aspirin 75-100 mg daily starting at 12-16 weeks
Explanation
This patient has multiple high-risk factors (type 1 diabetes, chronic hypertension). ACOG recommends low-dose aspirin (81-162 mg daily) initiated between 12 and 26 weeks, ideally before 16 weeks, for pre-eclampsia prevention in high-risk women. Indian practice commonly uses 75-100 mg. Option C is too late. Option B uses the ASPRE trial dose but nightly dosing is not standard ACOG recommendation. Option D is insufficient as sole prevention in high-risk patients.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.