Objective: To evaluate changes in the rates of hypertensive disorders of pregnancy (HDP) in the US after the publication of aspirin (ASA) recommendation guidelines by the USPSTF and ACOG.

Methods: A population-based retrospective cohort study was performed using the US Natality database. The pre-ASA group included births between 2010-2014. The post-ASA group were births between 2016-2021. Births in 2015 were excluded. Outcomes were rates of HDP. Univariate and multivariate analyses were performed. Using the 2010-2014 HDP trend, a projected trend was calculated and compared to the actual trend across the entire cohort.

Results: There were 12,127,659 births in the pre-ASA group and 17,665,217 births in the post-ASA group. The post-ASA group had a significantly higher rate of overall HDP than the pre-ASA group (7.7 % vs 4.9 %; aOR 1.58, 95 % CI [1.57-1.59]). When stratified by gestational age at delivery, the post-ASA group had a significantly lower rate of preterm HDP prior to 37 weeks (21.6 % vs 23.7 %; aOR 0.90, 95 % CI [0.89-0.91]) and preterm HDP prior to 34 weeks (6.0 % vs 7.5 %; aOR 0.79, 95 % CI [0.78-0.81]). The actual HDP trend post-ASA recommendation was higher than projected for overall HDP and preterm HDP < 37 weeks but was not different for preterm HPD < 34 weeks.

Conclusion: While overall HDP is increasing, the rate of preterm births complicated by HDP has been decreasing. The actual trend for the overall HDP category and the two preterm HDP categories, however, remains either higher or no different compared to the projected trend post aspirin recommendation guidelines.

Keywords: Aspirin; Hypertension; Preeclampsia; Preterm preeclampsia.

Published by Elsevier B.V.

目标: 评估在美国预防服务工作组（USPSTF）和美国妇产科医师学会（ACOG）发布阿司匹林推荐指南后，妊娠期高血压疾病（HDP）的发病率变化。

方法: 使用美国出生数据库进行了一项基于人口的回顾性队列研究。2010-2014年期间的分娩被纳入预阿司匹林组，而2016-2021年期间的分娩则被视为后阿司匹林组。2015年的数据被排除在外。结果是HDP的发生率。进行了单变量和多变量分析。根据2010-2014年的HDP趋势计算了一个预测的趋势，并与整个队列的实际趋势进行了比较。

结果: 在预阿司匹林组中，共有12,127,659例分娩，在后阿司匹林组中有17,665,217例分娩。与预阿司匹林组相比，后阿司匹林组的整体HDP发生率显著较高（7.7% vs 4.9%，校正优势比为1.58，95%置信区间[1.57-1.59]）。根据分娩时的妊娠周数分层分析显示，在37周前，后阿司匹林组的早发HDP发生率显著较低（21.6% vs 23.7%，校正优势比为0.90，95%置信区间[0.89-0.91]），以及在34周前（6.0% vs 7.5%，校正优势比为0.79，95%置信区间[0.78-0.81]）。阿司匹林推荐后的实际HDP趋势高于预测的整体HDP和早发HDP

结论: 虽然整体的HDP在增加，但由HDP导致的早产率却在下降。然而，在阿司匹林推荐指南后，总体HDP类别和两个早发HDP类别的实际趋势与预测的趋势相比更高或没有差异。

关键词: 阿司匹林；高血压；子痫前期；早发性子痫前期。