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Antenatal aspirin prescription following the United States Preventive Services Task Force (USPSTF) 2021 practice
Ashten B Waks1, Gina Milone2, Megan C Oakes3
1Department of Obstetrics and Gynecology, MemorialCare Miller Children's and Women's Hospital Long Beach, Long Beach, CA, USA; Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of California Irvine, Orange, CA, USA.
Insights
Aspirin is recommended for preeclampsia prevention, but only 55% of at-risk patients received it. High-risk patients were more likely to get aspirin than moderate-risk patients.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Preventive Cardiology
Background:
- The United States Preventive Services Task Force (USPSTF) recommends aspirin for preeclampsia prophylaxis.
- Despite recommendations, aspirin uptake for preeclampsia prevention remains low, with less than 15% of eligible patients correctly treated.
Purpose of the Study:
- To evaluate the rate of aspirin prescription for preeclampsia prophylaxis after the USPSTF's 2021 guideline updates.
- To compare aspirin prescription rates between patients with moderate and high risk factors for preeclampsia.
Main Methods:
- A retrospective study analyzed 1203 patients receiving prenatal care before 16 weeks and delivered between January 1 and December 31, 2022.
- Preeclampsia risk was assessed using 2021 USPSTF guidance. Aspirin prescription rates were determined using chi-square tests.
- Logistic regression compared the odds of appropriate aspirin prescription between moderate and high-risk groups.
Main Results:
- Of 1203 patients, 55% were appropriately prescribed aspirin for preeclampsia prophylaxis.
- Patients with one high-risk factor had an 80% aspirin prescription rate, significantly higher than the 42% rate for those with multiple moderate risk factors (p < 0.001).
- The odds of aspirin prescription were over 5 times greater for high-risk patients compared to moderate-risk patients (aOR 5.18).
Conclusions:
- Aspirin prescription for preeclampsia prophylaxis remains suboptimal, with only half of eligible patients receiving treatment.
- Patients with moderate risk factors were significantly less likely to be prescribed aspirin, indicating a gap in care.
- There is a critical need for public health interventions and provider education to improve aspirin use for preeclampsia prevention.
Background:
The United States Preventive Services Task Force (USPSTF) recommends aspirin for patients at risk for preeclampsia, though less than 15% are correctly treated.
Objective:
1) Assess the rate of aspirin prescription for preeclampsia prophylaxis following the USPSTF's 2021 practice updates. 2) Compare the odds of aspirin prescription between patients with moderate and high risk factors for preeclampsia.
Study Design:
Retrospective study of patients with prenatal care before 16w0d and delivered in our health system between 1/1- 12/31/2022. Preeclampsia risk was assigned according to 2021 USPSTF guidance. Primary outcome was aspirin prescription for preeclampsia prophylaxis, assessed using chi-square tests. Odds of correct aspirin prescription were also compared between risk groups using logistic regression.
Results:
Of 1203 patients, 159 (13%) had 1 or more high risk and 288 (24%) had 2 or more moderate risk factors for preeclampsia. Only 246 (55%) were appropriately prescribed aspirin. Patients with 1 high risk factor were significantly more likely to be prescribed aspirin than those with multiple moderate risk factors (80% vs 42%, p < 0.001). The odds of aspirin prescription were 5 times greater among patients with at least 1 high risk factor relative to those with multiple moderate risk factors (OR 5.38, 95% CI 3.34 - 8.68; aOR 5.18, 95% CI 3.20 - 8.37).
Conclusions:
Only half of our patients were correctly prescribed aspirin, a trend more pronounced among those with moderate risk factors for preeclampsia. This highlights an opportunity for public health interventions and provider education regarding the benefit of aspirin in this population.
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