JAMA Netw Open

USPSTF guidelines may overestimate preeclampsia risk in pregnancy

August 14, 2025

Study details: This prospective cohort study assessed the utility of USPSTF guidelines for preeclampsia risk stratification and aspirin prophylaxis (AP) in 5,684 pregnant individuals across 11 U.S. sites. Participants were categorized as low, moderate, or high risk based on USPSTF criteria, and AP recommendations were tracked.

Results: Of the cohort, 89% were classified as at increased risk (70% moderate, 19% high). Preeclampsia occurred in 12% overall, with rates of 3% in low-risk, 11% in moderate-risk, and 24% in high-risk groups. Among those with ≥2 moderate risk factors, only nulliparity was significantly associated with increased relative risk (1.48); other factors like obesity, Black race, and advanced maternal age showed limited or no predictive value. AP was recommended to 82% of high-risk patients and 86% of low-risk patients were correctly not recommended AP. However, only 50% of those with ≥2 moderate risk factors received AP, and just 24% with one moderate risk factor were offered it.

Clinical impact: USPSTF guidelines may lack specificity, particularly for moderate-risk patients, leading to inconsistent prophylaxis. Enhanced risk models could better guide aspirin use and improve maternal outcomes.

Source:

McElrath TF, et al. (2025, July 17). JAMA Netw Open. Utility of the US Preventive Services Task Force for Preeclampsia Risk Assessment and Aspirin Prophylaxis. https://pubmed.ncbi.nlm.nih.gov/40674048/