Aspirin 12 Weeks Pre-eclampsia Prevention CKD — ESENeph MCQ

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EasyPregnancy & RenalAspirin 12 Weeks Pre-eclampsia Prevention CKDESENeph

A 33-year-old woman at 14 weeks' gestation has CKD G3a (eGFR 48 mL/min/1.73m2) with uACR 55 mg/mmol. She is not on aspirin. According to NICE NG133, when should low-dose aspirin be started for pre-eclampsia prevention in this patient?

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Correct answer: D — From 12 weeks — she should have started already

NICE NG133 recommends low-dose aspirin (75-150 mg daily) from 12 weeks' gestation until delivery for women at high risk of pre-eclampsia. CKD is a high-risk factor. This patient should have started aspirin at 12 weeks — she is now 14 weeks and should start immediately. The evidence (ASPRE trial) shows that aspirin started before 16 weeks is most effective at preventing preterm pre-eclampsia. Starting after 16 weeks has diminished benefit. One high-risk factor (CKD, chronic hypertension, previous pre-eclampsia, autoimmune disease, diabetes) or two moderate-risk factors (first pregnancy, age >40, BMI >35, family history) are the indications.

Reference: NICE 2019 – NG133 Hypertension in Pregnancy; Rolnik et al 2017 – ASPRE Trial