Closing the Gap Between Recommendation and Uptake: Provider Communication About Low-Dose Aspirin for Preeclampsia...

Hypertensive disorders of pregnancy (HDPs), including preeclampsia, disproportionately contribute to preventable maternal morbidity and mortality. This study examined variations in clinician counseling and management of HDPs, provider communication about low-dose aspirin (LDA) prophylaxis, and barriers and facilitators to patient activation.

A cross-sectional, mixed-methods study was conducted with perinatal care providers at two Midwest academic medical centers (2021-2022). An online survey was completed by 74 providers, followed by semi-structured interviews with a purposive sample of 13 providers. Survey data were analyzed descriptively using SAS 9.4; interview transcripts were analyzed using deductive thematic analysis with intercoder reliability.

All interviewed providers recommended LDA initiation between 12- and 16-weeks' gestation. Primary barriers included limited medication adherence (43%) and appointment non-attendance (16.5%). Facilitators included LDA's low cost, over-the-counter availability, and established safety profile. Themes include initiating conversations about LDA with all patients regardless of risk, emphasizing universal LDA uptake, and recognizing continued preeclampsia risk postpartum.

Providers demonstrated familiarity with HDP guidelines but exhibited inconsistencies in counseling. Reframing "patient compliance" as "patient activation" supports equity-centered shared decision-making. Recommended strategies include establishing universal LDA recommendation protocols, expanding Medicaid coverage to reduce insurance barriers, and implementing community-focused public health education initiatives.