1. 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

2. 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 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

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

4. 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

5. 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