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Missed opportunities in aspirin prescribing for preeclampsia prevention
Noreen Singh1,2, Saskia Shuman3, Jacqueline Chiofalo3
1The Institute for Family Health, 230 W 17th St, New York, NY, 10011, USA. nosingh@institute.org.
Insights
Low-dose aspirin can prevent preeclampsia, a major cause of maternal mortality. However, many at-risk pregnant individuals, especially those with multiple moderate-risk factors, do not receive this crucial aspirin prophylaxis.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Health
- Health Disparities
Background:
- Preeclampsia is a significant cause of maternal and infant morbidity and mortality in the U.S.
- Low-income and marginalized populations are disproportionately affected.
- Low-dose aspirin prophylaxis is recommended for individuals at increased risk of preeclampsia.
Purpose of the Study:
- To examine preeclampsia risk factors and aspirin prescribing patterns in patients receiving care at federally qualified health centers (FQHCs).
- To identify patient groups at highest risk of not receiving recommended aspirin prophylaxis.
Main Methods:
- Retrospective chart review of 523 pregnant individuals (ages 18-50) who received at least two prenatal visits between January 2019 and December 2020.
- Analysis of prescription patterns for patients at moderate and high risk for preeclampsia using logistic regression models.
Main Results:
- Only 39% of 249 at-risk patients received an aspirin prescription.
- Patients with high-risk factors were prescribed aspirin 57.89% of the time, while those with multiple moderate-risk factors received prescriptions only 27.27% of the time.
- Aspirin prescribing was highest for patients with a history of preeclampsia or hypertension, but still below optimal levels.
Conclusions:
- Despite guidelines, there are missed opportunities for preeclampsia prevention with aspirin.
- Interventions should target patients with multiple moderate-risk factors who may not have high-risk comorbidities.
Background:
Hypertensive disorders of pregnancy, including preeclampsia, are a leading cause of perinatal morbidity and mortality in the United States, particularly among low-income and historically marginalized populations. Evidence suggests low-dose aspirin prophylaxis may help prevent preeclampsia in individuals at increased risk of developing the disease. This study examines associations between preeclampsia risk factors and aspirin prescribing practices among patients receiving prenatal care at a network of federally qualified health centers (FQHC).
Methods:
Researchers conducted retrospective chart reviews (n = 523) of pregnant individuals ages 18-50 who completed two or more prenatal visits at the FQHC between January 1, 2019 and December 31, 2020. Prescription patterns for patients at moderate and high risk for preeclampsia were analyzed using unadjusted and adjusted logistic regression models to identify the patients with the greatest risk of not receiving the recommended prophylactic treatment.
Results:
Of 249 total patients considered at risk for preeclampsia, only 39% received an aspirin prescription. 57.89% of patients with any high-risk factor were appropriately prescribed aspirin, but only 27.27% of patients with two or more moderate-risk factors without high-risk factors received a prescription. Clinicians most frequently prescribed aspirin for patients with a history of preeclampsia and history of hypertension. However, aspirin was prescribed a maximum of 78.79% of the time for patients with a prior history of hypertension. Among moderate-risk factors, patients with advanced maternal age, Black race, or nulliparity were significantly more likely in adjusted models to be prescribed aspirin.
Conclusions:
Despite the documented benefits of aspirin prescribing and support from professional societies, there are still many missed opportunities for aspirin prophylaxis to prevent preeclampsia. Future interventions should focus on identifying patients who qualify for aspirin prophylaxis on the basis of having multiple moderate-risk factors without comorbid high-risk factors.
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