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Gaps in Low-Dose Aspirin Use for Preeclampsia Prevention: Insights and Clinical Implications
Nadir Ganem1, Maya Frank Wolf1,2, Raneen Sawaid Kayal1
1Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.
Insights
Low-dose aspirin for preeclampsia prevention is underprescribed, particularly for moderate-risk pregnancies. Gaps in care highlight the need for improved provider education and consistent risk assessment to ensure guideline adherence.
Area of Science:
- Obstetrics and Gynecology
- Pharmacology
- Public Health
Background:
- Preeclampsia is a serious pregnancy complication.
- Low-dose aspirin is recommended for preeclampsia prophylaxis in high-risk women.
- Current guidelines (Israeli and ACOG) vary in criteria for moderate-risk factors.
Purpose of the Study:
- To assess real-world low-dose aspirin prescribing for preeclampsia prevention.
- To identify prescribing disparities based on risk factors and demographics.
- To evaluate adherence to Israeli and ACOG guidelines for prophylaxis.
Main Methods:
- Retrospective analysis of over 18,000 deliveries at a tertiary medical center (March 2020 - April 2024).
- Eligibility for low-dose aspirin assessed using both Israeli and ACOG criteria.
- Prescription patterns analyzed against risk factors, demographics, and guideline recommendations.
Main Results:
- Only 6.2% met Israeli criteria, with 44.1% receiving aspirin; 13.6% met ACOG criteria, with 27.9% receiving it.
- Prescription rates were lower for chronic hypertension and autoimmune diseases compared to history of preeclampsia or diabetes.
- Arab women received aspirin more frequently than Jewish women; high-risk factors strongly predicted prescription.
Conclusions:
- Suboptimal prescription of low-dose aspirin for preeclampsia prevention was observed.
- Significant gaps exist, especially for moderate-risk women and certain high-risk groups.
- Improved provider education and implementation strategies are needed for better guideline adherence.
Objective:
To evaluate real-world prescribing patterns of low-dose aspirin for preeclampsia prevention among pregnant women who met the Israeli or American College of Obstetricians and Gynecologists (ACOG) guideline criteria for preeclampsia prophylaxis, and to identify disparities and missed opportunities in implementing risk-based prophylaxis in a diverse obstetric population.
Methods:
This retrospective study analyzed women who delivered live births at a tertiary medical center in northern Israel between March 2020 and April 2024. Eligibility for low-dose aspirin prophylaxis was assessed using Israeli guidelines, focusing on major risk factors, and the broader ACOG criteria, which include moderate-risk factors. This dual approach reflects debates in Israel about incorporating moderate-risk factors into routine clinical practice.
Results:
Of 18,838 women included, 1,160 (6.2%) met the criteria for low-dose aspirin prophylaxis under Israeli guidelines, and 511 (44.1%) of these received prescriptions. The prescription rate was highest among women with a history of preeclampsia (79.0%) and pregestational diabetes (66.3%) but notably lower among those with chronic hypertension (30.3%) and autoimmune diseases (41.3%). Under ACOG criteria, 2,559 women (13.6%) were eligible for low-dose aspirin, but only 27.9% (715/2,559) received prophylaxis. The prescription rate was significantly higher among women with high-risk factors than among those with only moderate-risk factors (OR=0.16, p<0.001). Arab women were more likely to receive low-dose aspirin than were Jewish women (31.2% vs 24.5%, p<0.001), consistent with higher prevalences of risk factors. Multivariate analysis showed that a history of preeclampsia (OR=7.15, p<0.001) and pregestational diabetes (OR=3.80, p<0.001) were strongly associated with low-dose aspirin prescription.
Conclusion:
Our findings reveal suboptimal prescription of low-dose aspirin according to guideline criteria, especially among women with moderate-risk factors. Even among women with high-risk factors, disparities in prescribing practices persisted. These gaps highlight the need for better provider education, consistent risk assessment, and structured implementation strategies to improve guideline adherence.
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