Bridging the Gaps between Aspirin Guidelines and Pregnancy Outcomes

Currently birth outcomes in the United States lag other industrialized countries and are driven predominantly by adverse pregnancy outcomes including preeclampsia, spontaneous preterm birth, stillbirth and fetal growth restriction. In aggregate these conditions are termed adverse pregnancy outcomes (APOs) and are complex in their origin, but largely reflect placentally mediated conditions that begin in early pregnancy. Low-dose aspirin (LDA) has been shown to lower the risk of APOs, but questions about the optimal dose, patient population to receive it, and barriers to prescribing and adherence have limited the impact of LDA on a population level. Multiple investigations unfortunately have shown that uptake is low and often biased in its provision. To address these inequities in care, the Delaware Perinatal Quality Collaborative (DPQC) organized efforts around standardizing screening all patients, providing hospital level feedback and enhanced patient education. With this effort, the rate of appropriate LDA prescription increased from 10% to 65%. Further studies and thoughtful conversations around additional barriers to care must be addressed jointly by researchers, providers, public health officials, patients and the community at large if the full promise shown in randomized controlled trials is to be realized.