SMFM Special Statement 2026 · USPSTF 2021 · ACOG/SMFM Practice Advisory 2026
Version December 2025
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Select risk factors below to generate recommendation
Check all that apply — result updates automatically
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🔴 High-risk: 0
🟡 Moderate-risk: 0
Total selected: 0
⚠ HIGH-RISK FACTORS
Recommend aspirin if ANY are present
◑ MODERATE-RISK FACTORS
Recommend if >1 present · Consider if ★ alone
Evidence Base & Clinical Background
3–4%
Preeclampsia incidence in US pregnancies
~20%
Risk reduction with low-dose aspirin prophylaxis
~85%
of pregnancies now qualify for aspirin consideration
~33%
of pregnancies qualify for aspirin recommendation
Key Changes: 2021 USPSTF Update vs. 2014
Aspirin now recommended (not just considered) for patients with >1 moderate-risk factor
Aspirin now considered for Black or lower-income individuals, even as the sole risk factor (new)
IVF added as a moderate-risk factor (new)
"African ancestry" updated to "Black or African American"
"Low socioeconomic status" updated to "lower income"
81 mg daily
12–28 weeks gestation
Before 16 weeks
Continue until delivery
Dosing note: Emerging evidence suggests 162 mg/day may be more efficacious than 81 mg in high-risk obese individuals (ASPREO trial, Amro et al. 2025; Ghesquiere et al. 2023), but current USPSTF/ACOG/SMFM guidelines recommend 81 mg. Safety data for higher doses require further evaluation (Cluver et al. 2023).
Source Publications — Vancouver Format
1. PRIMARY SOURCE
Society for Maternal-Fetal Medicine (SMFM), Ghartey J, Combs CA; SMFM Patient Safety and Quality Committee. Society for Maternal-Fetal Medicine Special Statement: Updated checklists for preeclampsia risk-factor screening to guide recommendations for prophylactic low-dose aspirin. Pregnancy. 2026;2:e70212.
This tool is built directly on this SMFM Special Statement. Replaces the 2020 SMFM version.
2. GUIDELINE
US Preventive Services Task Force, Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, et al. Aspirin use to prevent preeclampsia and related morbidity and mortality: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;326(12):1186–91.
Defines the 2021 risk factor classification system (high-risk, moderate-risk, asterisked factors) underlying this checklist.
3. PRACTICE ADVISORY
American College of Obstetricians and Gynecologists, Society for Maternal Fetal Medicine. Low-Dose Aspirin Use for the Prevention of Preeclampsia and Related Morbidity and Mortality. Washington, DC: ACOG; January 21, 2026.
Affirms USPSTF 2021 recommendations; adds guidance on dosing, timing, and universal aspirin use in high-prevalence practices.
4. EFFICACY META-ANALYSIS
Roberge S, Bujold E, Nicolaides KH. Aspirin for the prevention of preterm and term preeclampsia: systematic review and metaanalysis. Am J Obstet Gynecol. 2018;218(3):287–93.e1.
Supports the ~20% risk reduction estimate for aspirin started in early pregnancy.
5. PREVALENCE
Wheeler SM, Myers SO, Swamy GK, Myers ER. Estimated prevalence of risk factors for preeclampsia among individuals giving birth in the US in 2019. JAMA Netw Open. 2022;5(1):e2142343.
Basis for the ~85% "considered or recommended" and ~33% "recommended" prevalence estimates.
6. RCT — HIGHER DOSE
Amro FH, Blackwell SC, Pedroza C, Backley S, Bitar G, Daye N, et al. Aspirin 162 mg vs 81 mg for preeclampsia prophylaxis in high-risk obese individuals: a comparative effectiveness open-label randomized trial (ASPREO). Am J Obstet Gynecol. 2025;232(3):315.e1–e8.
Suggests 162 mg may outperform 81 mg in high-risk obese individuals; further evidence needed before changing standard practice.
7. BLEEDING RISK
Hastie R, Tong S, Wikstrom AK, Sandstrom A, Hesselman S, Bergman L. Aspirin use during pregnancy and the risk of bleeding complications: a Swedish population-based cohort study. Am J Obstet Gynecol. 2021;224(1):95.e1–e12.
Context for safety of universal aspirin prophylaxis; higher-dose regimens require more safety data.
8. CHECKLIST IMPLEMENTATION
Zhou MK, Combs CA, Pandipati S, Del Rosario A. Association of checklist usage with adherence to recommended prophylactic low-dose aspirin for prevention of preeclampsia. Am J Obstet Gynecol. 2023;228(3):349–51.e2.
Shows that structured checklist use increases aspirin prescribing for eligible patients and reduces errors of omission.
This tool is a clinical decision support aid. It does not replace clinical judgment. Clinicians should be familiar with and comply with all applicable laws and regulations. Produced by Amos Grünebaum, MD · obmd.com
