Summary4 min read

Podcast Episode Summary

Episode Overview

Podcast: The OB/GYN Resident Survival Guide
Host: Dr. KC Miller
Episode: #25: Preeclampsia Risk Factors (And When to Start Aspirin)
Date: June 21, 2026

This episode delivers a focused, high-yield review of the risk factors for preeclampsia and practical guidance on when to initiate low-dose aspirin for prevention. Dr. KC Miller, drawing from ACOG guidelines and her real-world expertise, provides a structured summary ideal for OB/GYN residents, medical students, and clinicians aiming to internalize core management pearls for day-to-day practice and exam readiness.

Key Discussion Points & Insights

1. Significance of Preeclampsia

[01:22]

Preeclampsia affects 3–8% of pregnancies worldwide.
Hypertensive disorders account for 16% of maternal deaths.
The condition is commonly encountered, making its prevention a core clinical skill for anyone caring for pregnant patients.

"Whether you are a seasoned attending or a third year med student, ...chances are you've cared for a patient whose pregnancy was complicated by this condition." — Dr. KC Miller [01:34]

2. Why Focus on Risk Factors?

[01:44]

Emphasis on disease prevention in addition to treatment.
Understanding risk factors is critical for guiding evidence-based preventative interventions.

3. Risk Factor Classification

[02:00]
Dr. Miller organizes risk factors into two categories:

High Risk: Each individual factor confers an ≥8% expected risk.
Moderate Risk: Each contributes moderately, but two or more in combination increase risk substantially.

High Risk Factors for Preeclampsia

[02:24]

Seven conditions confer high risk.

Personal history of preeclampsia
Chronic hypertension
Pre-gestational diabetes (Type 1 or 2)
Autoimmune disorders (e.g., lupus, antiphospholipid antibody syndrome)
Renal disease
Multifetal gestation (twins, triplets, etc.)

"Factors in the high risk category are the comorbid conditions that would individually confer an expected 8% or greater risk for developing preeclampsia during pregnancy." — Dr. KC Miller [02:10]

Moderate Risk Factors for Preeclampsia

[03:04]

Moderate risk factors include:

Pregnancies conceived via IVF
Obesity (BMI ≥30)
Nulliparity (first pregnancy)
Family history (mother or sister with preeclampsia)
Low income/low socioeconomic status
Advanced maternal age (≥35 by due date)
History of adverse pregnancy outcomes (e.g., SGA fetus, low birth weight infant)
>10-year interval since last delivery
Black race*
Caveat emphasized: The increased risk in Black individuals is due to racism and social/structural inequities—not biology.

"It's important to note that Black individuals do not have a biological propensity for preeclampsia. This is a risk factor due to racism and the associated social and structural inequities that come with that." — Dr. KC Miller [04:06]

When to Start Aspirin for Preeclampsia Prevention

[04:48]

Guidelines from:
- American College of Obstetricians and Gynecologists (ACOG)
- Society for Maternal-Fetal Medicine
- US Preventive Services Task Force
Recommendation:
- Initiate low-dose aspirin (between 12–28 weeks, ideally 12–16 weeks gestation)
- Who qualifies:
  - Patients with one high risk factor
  - OR two or more moderate risk factors

"...support the initiation of low dose aspirin between 12 and 28 weeks gestation, ideally between 12 and 16 weeks gestation, to prevent or delay the onset of preeclampsia in pregnancy in those with one high risk factor or two or more moderate risk factors." — Dr. KC Miller [04:48]

References for further reading mentioned (ACOG Practice Advisory and Committee Opinion).

Notable Quotes & Memorable Moments

On the necessity of prevention:
"In medicine, we focus a lot on the treatment of disease, but of course it's imperative to focus on disease prevention." — Dr. KC Miller [01:44]
Clarifying the role of social factors:
"It's important to note that Black individuals do not have a biological propensity for preeclampsia. This is a risk factor due to racism and the associated social and structural inequities that come with that." — Dr. KC Miller [04:06]
On starting aspirin:
"...initiation of low dose aspirin between 12 and 28 weeks gestation, ideally between 12 and 16 weeks gestation..." — Dr. KC Miller [04:48]

Timestamps for Key Segments

00:00–01:12 — Introduction and brief promo for OB GYN Residency Bootcamp (skipped for summary per instruction)
01:22 — Overview: Preeclampsia impact and prevalence
01:44 — Importance of understanding risk factors for prevention
02:00–02:24 — High vs. moderate risk factor classification explained
02:24–03:04 — High risk factors listed and discussed
03:04–04:06 — Moderate risk factors listed and discussed; social determinants emphasized
04:48–05:32 — Aspirin prevention guidelines recapped
05:32–end — References and episode wrap-up (excluded for summary)

Practical Takeaways

Memorize high and moderate risk factors for preeclampsia to identify candidates for aspirin prophylaxis.
Start low-dose aspirin between 12–28 weeks (ideally 12–16 weeks) for qualifying patients.
Recognize that risk factors—including race—can reflect societal inequities and require careful, sensitive discussions with patients.
Refer to ACOG Practice Bulletins and Committee Opinions for up-to-date, detailed recommendations.

For detailed algorithms, clinical workflow guides, and more OBGYN residency survival resources, see Dr. Miller's website or the show notes.

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Transcript1 lines

[00:00]
A
Welcome back for another episode of the OB GYN Resident Survival Guide. Today is going to be a quick overview of the risk factors for preeclampsia. Before I jump in, I wanted to let you know that the doors to OB GYN Residency Boot Camp are open. OBGYN Residency Boot Camp is a five module course that covers the essential information you need to get started on July 1st with labor and delivery, OB triage, postpartum emergency gynecology and ambulatory care. The step by step workflows for the clinical scenarios that come up again and again in your intern year and throughout residency. We all know that starting intern year is like drinking from a fire hose, but drinking from a fire hose is a lot easier when you've got solid ground to stand on. OB GYN Residency Bootcamp provides real algorithms and workflows for to prepare you for day one and a reference library that you can keep coming back to all year long. If platforms like Sketchy Medical Pathoma or Online Med Ed got you through med school, then OB GYN residency bootcamp is built for you. Doors close on June 30, so if you've been on the fence, now is the time to make the call. The link to learn more and enroll is in the show Notes all right, let's jump into the episode. About 3 to 8% of pregnancies worldwide are estimated to be affected by preeclampsia and 16% of maternal deaths are attributable to hypertensive disorders in pregnancy. In general, whether you are a seasoned attending or a third year med student, having done only one single labor and delivery rotation, the chances are you've cared for a patient whose pregnancy was complicated by this condition. In medicine, we focus a lot on the treatment of disease, but of course it's imperative to focus on disease prevention. And in order to prevent disease, we have to understand what risk factors exist for a whole variety of medical conditions. So today I'm going to focus specifically on risk factors for preeclampsia and I'll break them down into two categories, the high risk risk factors and the moderate risk risk factors. Factors in the high risk category are the comorbid conditions that would individually confer an expected 8% or greater risk for developing preeclampsia during pregnancy. Factors in the moderate risk category are each associated with preeclampsia, but it's the combination of two or more of them that substantially increase that risk. So what risk factors are in the high risk category? There are seven of them. A personal history of preeclampsia chronic chronic hypertension pre gestational diabetes, so type 1 or type 2 diabetes autoimmune diseases. Some examples include lupus or antiphospholipid antibody syndrome and then renal disease and multifetal gestation, SO twins, triplets, et cetera. Moderate risk factors include pregnancies conceived via in vitro fertilization obesity, meaning a BMI of 30 or greater nulliparity a family history of preeclampsia in the patient's mother or sister low income or low socioeconomic status advanced maternal age, meaning an age of 35 or greater by the estimated due date a history of adverse pregnancy outcomes, for example A small for gestational age, fetus or an infant with a low birth weight, a greater than 10 year interval since the last delivery and Black race It's important to note that Black individuals do not have a biological propensity for preeclampsia. This is a risk factor due to racism and the associated social and structural inequities that come with that. So what do we do with this information? The American College of Obstetricians and Gynecologists, the Society for Maternal Fetal medicine and the U.S. preventative Services Task Force support the initiation of low dose aspirin between 12 and 28 weeks gestation, ideally between 12 and 16 weeks gestation, to prevent or delay the onset of preeclampsia in pregnancy in those with one high risk factor or two or more moderate risk factors. If you want to read more about low dose aspirin use in pregnancy for preeclampsia prevention, I've referenced the ACOG Practice Advisory and Committee opinion in the Show Notes. That's it for today. As usual, the references are listed in the show notes along with the link to learn more about OB GYN Residency Boot Camp have a great week.