Risk Factors Preeclampsia in previous pregnancies severity of preeclampsia strongly impacts this risk. Women with severe features of preeclampsia in the second trimester are at greatest risk of developing preeclampsia in a subsequent pregnancy: rates of 25 to 65% Women without severe features in first pregnancy develop preeclampsia in 5-7% of second pregnancies Women who had normotensive first pregnancies develop preeclampisa in < 1% of second pregnancies

Prevention Aspirin (81 mg) has a small to moderate effect on preeclampsia prevention (NNT = 72) Those at highest risk are more likely to benefit (NNT = 19) Start aspirin 12-14 weeks for those at risk ACOG and USPSTF recommend to treat those with history of preeclampsia (especially early onset or with adverse outcome), or with high-risk factors

Risk Factors Type 1 and 2 DM Chronic HTN Multifetal pregnancies Renal or autoimmune diseases

Adapted from USPSTF 2014 Recommendations Table 1 Risk Level Risk Factors Recommendation High History of preeclampsia, especially when accompanied by an adverse outcome Multifetal gestation Chronic hypertension Type 1 or 2 diabetes Renal disease Autoimmune disease (systemic lupus erythematous, antiphospholipid syndrome) Recommend low-dose aspirin if the patient has ≥1 of these high-risk factors Moderate Nulliparity Obesity (body mass index >30 kg/m2) Family history of preeclampsia (mother or sister) Sociodemographic characteristics (African American race, low socioeconomic status) Age ≥35 years Personal history factors (e.g., low birthweight or small for gestational age, previous adverse pregnancy outcome, >10-year pregnancy interval) Consider low-dose aspirin if the patient has several of these moderate-risk factors Low Previous uncomplicated full-term delivery Do not recommend low-dose aspirin Adapted from USPSTF 2014 Recommendations Table 1

Calcium Supplementation May decreases mortality risk, HTN, and pre-e in women with low calcium intake Per ACOG, women in developed countries like the USA are unlikely to benefit