Design Preeclampsia Prevention Protocol

---
name: design-preeclampsia-prevention-protocol
description: Use when managing preeclampsia risk during pregnancy — e.g., "low-dose aspirin during pregnancy", "high blood pressure pregnancy", "preeclampsia prevention for high-risk pregnancy", "monitoring BP while pregnant"
source: ACOG Practice Bulletin 222 (2020); USPSTF Preeclampsia Prevention 2021; Roberge et al. AJOG 2017 (aspirin meta-analysis); Cochrane Aspirin Preeclampsia 2019
tags: [pregnancy, preeclampsia, hypertension, aspirin, blood-pressure, health]
verified: true
---

# Design Preeclampsia Prevention Protocol

Use risk stratification, low-dose aspirin, and monitoring to reduce preeclampsia risk and detect it early.

## Why This Is Best Practice

**Adopted by:** ACOG, USPSTF, NICE, WHO — all recommend low-dose aspirin for high-risk patients based on Class A evidence.
**Impact:** Low-dose aspirin (81 mg/day) initiated before 16 weeks reduces preterm preeclampsia by 62% (Roberge meta-analysis, AJOG 2017, 45 RCTs, n=20,909). Preeclampsia is responsible for 76,000 maternal deaths and 500,000 fetal deaths annually (WHO 2011).
**Why best:** Preeclampsia has no cure except delivery. Prevention in high-risk women and early detection in all women are the only levers.

## Steps

1. **Risk stratify at first prenatal visit:**
   - **High risk (1+ factor):** prior preeclampsia, chronic hypertension, DM1/DM2, kidney disease, autoimmune (SLE/APS), multifetal gestation
   - **Moderate risk (2+ factors):** nulliparity, BMI >30, family history, age >35, low socioeconomic status, inter-pregnancy interval >10 years
2. **Prescribe low-dose aspirin if high-risk or 2+ moderate risk factors:**
   - Dose: 81 mg/day (not 325 mg)
   - Start: 12–16 weeks (before 16 weeks for maximum benefit)
   - Continue through 36 weeks gestation
3. **Calcium supplementation:** 1,000–1,500 mg/day if dietary intake is low — reduces preeclampsia risk in low-calcium populations (WHO 2016).
4. **BP monitoring at every prenatal visit:** thresholds:
   - Severe: ≥160/110 mmHg — treat within 30–60 minutes, do not wait
   - Elevated: 140–159/90–109 mmHg → increase visit frequency, 24-hour urine protein, labs
5. **Home BP monitoring (high-risk patients):**
   - Upper arm cuff (wrist cuffs less accurate in pregnancy)
   - Log readings at rest; alert provider if consistently ≥140/90
6. **Educate on warning signs** — see design-pregnancy-complication-action-plan for full list.

## Rules

- Aspirin must start before 16 weeks to be effective — starting after 20 weeks has minimal benefit.
- Stop aspirin at 36 weeks (reduces bleeding risk at delivery); earlier if placenta previa confirmed.
- Never treat severe hypertension (≥160/110) in pregnancy with "watchful waiting" — acute treatment prevents stroke.

## Examples

**High-risk patient (prior preeclampsia):** Start aspirin 81 mg at 12 weeks; home BP monitoring 2×/day from 20 weeks; 24-hour urine protein at 28 and 34 weeks.
**Moderate risk (nullipara, BMI 32):** Aspirin 81 mg if second moderate risk factor present; increase calcium to 1,200 mg/day.

## Common Mistakes

- Using 325 mg aspirin — only 81 mg is studied; 325 mg increases bleeding risk without additional benefit.
- Starting aspirin after 20 weeks and expecting full effect — the window is before 16 weeks.
- Missing the headache/visual change warning signs — these can precede eclamptic seizure by hours.

> **Health Disclaimer:** This is not medical advice. Preeclampsia risk assessment and aspirin prescribing require evaluation by a healthcare provider. Hypertension in pregnancy is a medical emergency. Contact your healthcare provider immediately for BP ≥140/90 or any warning symptoms.