Factors Associated with Guideline Concordant Clinician Counseling about Low-Dose Aspirin to Prevent Preeclampsia in Nulliparous Patients

Abstract

Objective The primary aim of this study was to examine the United States Preventative Services Task Force (USPSTF) guidelines concordant low-dose aspirin (LDA) counseling and factors associated with counseling in nulliparous birthing individuals.

Study Design We conducted a retrospective cohort study of nulliparous birthing individuals who delivered between January 1, 2019 and June 30, 2020 and received prenatal care at the Duke High Risk Obstetrical Clinics (HROB). All nulliparous patients over 18 years old who established or transferred care to HROB by 16 weeks, 6 days were included in the analysis. We excluded patients with more than two previous first-trimester pregnancy losses, multiple gestation, a known contraindication to LDA, initiation of LDA prior to their prenatal care, or documented medical history of coagulation disorder. Bivariate associations between demographic/medical characteristics and our primary outcome, receipt of counseling (yes/no), were assessed using two-sample t-tests for continuous variables and chi-square or Fisher's exact test for categorical variables. Factors significantly associated with the primary outcome (p < 0.05) were entered into the multivariable logistic regression model.

Results Among 391 birthing individuals included in the final analysis cohort, 51.7% of eligible patients received guideline consistent LDA counseling. Factors associated with increased odds of LDA counseling were advanced maternal age (adjusted odds ratio [aOR]: 1.05, 95% confidence interval [CI]: 1.01–1.09), Black race compared with White race (aOR:1.75, 95% CI: 1.03–2.98), chronic hypertension (aOR: 4.17, 95% CI: 1.82–9.55), and obesity (aOR: 5.02, 95% CI: 3.12–8.08).

Conclusion Approximately half of all nulliparous birthing individuals had appropriately documented LDA counseling. The USPSTF guidelines on LDA for preeclampsia risk reduction are complex, which may lead to ineffective provider adherence. Efforts to simplify guidelines and improve LDA counseling are vital to ensuring this low-cost, evidence-based preeclampsia prevention is used in a consistent and equitable manner.

Key Points

• A total of 51.7% of eligible patients received guideline consistent LDA counseling.

• Advanced maternal age , body mass index > 30, Black race, and chronic hypertension associated with increased odds of counseling.

• Among patients most likely to be counseled, high numbers did not receive LDA counseling.

Keywords

Preeclampsia - nulliparous - low-dose aspirin - patient counseling

Note

This work was presented as a poster at the 42nd Annual Maternal Meeting for the Society of Maternal-Fetal Medicine.

Publikationsverlauf

Eingereicht: 28. Januar 2023

Angenommen: 18. Mai 2023

Accepted Manuscript online:
19. Mai 2023

Artikel online veröffentlicht:
04. Juli 2023

• References

• 1 Fantasia HC. Low-dose aspirin for the prevention of preeclampsia. Nurs Womens Health 2018; 22 (01) 87-92
• 2 Henderson JT, Vesco KK, Senger CA, Thomas RG, Redmond N. Aspirin use to prevent preeclampsia and related morbidity and mortality: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2021; 326 (12) 1192-1206
• 3 Sacks GP, Studena K, Sargent K, Redman CW. Normal pregnancy and preeclampsia both produce inflammatory changes in peripheral blood leukocytes akin to those of sepsis. Am J Obstet Gynecol 1998; 179 (01) 80-86
• 4 Redman CW, Sargent IL. Immunology of pre-eclampsia. Am J Reprod Immunol 2010; 63 (06) 534-543
• 5 Davidson KW, Barry MJ, Mangione CM. et al; US Preventive Services Task Force. Aspirin use to prevent preeclampsia and related morbidity and mortality: US Preventive Services Task Force Recommendation Statement. JAMA 2021; 326 (12) 1186-1191
• 6 Henderson JT, Vesco KK, Senger CA, Thomas RG, Redmond NUS. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews. Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality. Agency for Healthcare Research and Quality (US); 2021
• 7 U.S. Preventive Services Task Force. Aspirin use to prevent preeclampsia and related morbidity and mortality: preventive medication. Accessed March 18, 2022 at: https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/low-dose-aspirin-use-for-the-prevention-of-morbidity-and-mortality-from-preeclampsia-preventive-medication
• 8 LeFevre ML. U.S. Preventive Services Task Force. Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 161 (11) 819-826
• 9 Hoffman MK, Goudar SS, Kodkany BS. et al. A description of the methods of the aspirin supplementation for pregnancy indicated risk reduction in nulliparas (ASPIRIN) study. BMC Pregnancy Childbirth 2017; 17 (01) 135
• 10 Hoffman MK, Goudar SS, Kodkany BS. et al; ASPIRIN Study Group. Low-dose aspirin for the prevention of preterm delivery in nulliparous women with a singleton pregnancy (ASPIRIN): a randomised, double-blind, placebo-controlled trial. Lancet 2020; 395 (10220): 285-293
• 11 ACOG Committee Opinion No. ACOG Committee Opinion No. 743: low-dose aspirin use during pregnancy. Obstet Gynecol 2018; 132 (01) e44-e52
• 12 Krishnamurti T, Davis AL, Rodriguez S, Hayani L, Bernard M, Simhan HN. Use of a smartphone app to explore potential underuse of prophylactic aspirin for preeclampsia. JAMA Netw Open 2021; 04 (10) e2130804
• 13 Wheeler SM, Myers SO, Swamy GK, Myers ER. Estimated prevalence of risk factors for preeclampsia among individuals giving birth in the US in 2019. JAMA Netw Open 2022; 5 (01) e2142343
• 14 Ayala NK, Rouse DJ. A nudge toward universal aspirin for preeclampsia prevention. Obstet Gynecol 2019; 133 (04) 725-728
• 15 Moyer VA. U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 160 (06) 414-420
• 16 Werner EF, Hauspurg AK, Rouse DJ. A cost-benefit analysis of low-dose aspirin prophylaxis for the prevention of preeclampsia in the United States. Obstet Gynecol 2015; 126 (06) 1242-1250
• 17 Mallampati D, Grobman W, Rouse DJ, Werner EF. Strategies for prescribing aspirin to prevent preeclampsia: a cost-effectiveness analysis. Obstet Gynecol 2019; 134 (03) 537-544
• 18 Bartsch E, Park AL, Kingdom JC, Ray JG. Risk threshold for starting low dose aspirin in pregnancy to prevent preeclampsia: an opportunity at a low cost. PLoS One 2015; 10 (03) e0116296
• 19 Roberge S, Villa P, Nicolaides K. et al. Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: a systematic review and meta-analysis. Fetal Diagn Ther 2012; 31 (03) 141-146