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The July 2018 American College of Obstetricians and Gynecologists' guidelines for aspirin prophylaxis for preeclampsia prevention represent a departure from prior, more stringent guidelines and extend eligibility for aspirin prophylaxis to a large proportion of pregnant women in the United States. However, these latest guidelines are predicated on a complex, risk-factor–based screening algorithm and ignore the reality that, outside of the setting of clinical research, effective implementation of risk-factor–based approaches consistently falls short. Herein we argue for transitioning to universal aspirin prophylaxis for preeclampsia prevention using the concept of libertarian paternalism, knowing that altering the choice architecture from an “opt-in” to an “opt-out” system will greatly increase the number of patients who receive the advantage of this inexpensive, safe, and beneficial preventative intervention.

Among women with gestational diabetes mellitus (GDM), hyperinsulinemic hypoglycemia of the neonate is a common complication because the hyperglycemic intrauterine environment leads to a relative increase in fetal insulin secretion (1). After delivery, persistent insulin elevation results in neonatal hypoglycemia that can be identified by clinical symptoms or routine screening. Exposure to GDM and hyperinsulinemic hypoglycemia have been associated with neurological sequelae and poor neurodevelopmental outcomes (1) as well as long-term metabolic abnormalities including type 2 diabetes and childhood obesity (2). Despite the morbidity associated with neonatal hypoglycemia, there is a paucity of data on predictors of the condition. The goal of this secondary analysis was to evaluate pregnancy characteristics among neonates who developed hypoglycemia within the first 24 h of life compared with those who did not. The prospective cohort study was performed at a single academic medical center between January 2016 and June 2018. Women included were $18 years old, diagnosed with GDM during their pregnancy, and enrolled during their postpartum hospitalization. Following enrollment, demographic, obstetric, and neonatal data were obtained from the electronic medical record.

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