Clinical Obstetrics
Poster Session 1
Taylor S. Freret, MD
Massachusetts General Hospital
Cambridge, MA, United States
Kaitlyn E. James, PhD, MPH (she/her/hers)
Massachusetts General Hospital
Boston, MA, United States
Anjali J. Kaimal, MD (she/her/hers)
Professor and Vice Chair of Clinical Operations, Department of OBGYN
University of South Florida Morsani College of Medicine
Tampa, FL, United States
.jpg "Mark A. Clapp, MD, MPH (he/him/his) photo")
Mark A. Clapp, MD, MPH (he/him/his)
Massachusetts General Hospital
Boston, MA, United States
The USPSTF recommends low-dose aspirin (LDA) for patients at risk of preeclampsia. Guidance from 2014 was updated in 2021, expanding recommendations for LDA. We sought to determine how the updated recommendation changed LDA use.
Study Design:
Retrospective cohort study of nulliparous patients with ≥2 moderate-risk factors and no high-risk factors delivering at ≥24 weeks gestation from 2017-2022 at four hospitals in one healthcare system. Patients were included if they established care before 14 weeks. USPSTF risk factors and aspirin use were obtained from the medical record. The primary outcome was LDA use, determined by presence on the medication list. Analyses used chi square test, with p< 0.05 considered significant.
Results:
The cohort included 31,555 patients, of whom 19,070 (60.4%) had risk factors for which LDA was recommended or should be considered. Of 5,473 patients for whom LDA was recommended, only 1,431 (26.2%) had use documented; this rate was 678/13,597 (5.0%) for patients in whom LDA should be considered. There was a significant change the makeup of USPSTF categories before and after the 2021 recommendation (p< 0.001, Figure). In 2022, 5,633 patients delivered; 2,369 (42.1%) patients had a new recommendation for LDA and 14.8% of these had LDA listed; 2,625 (46.6%) had a new indication for considering LDA and only 4.1% had LDA listed. Among nulliparous patients with no high-risk and one additional moderate-risk factor (to nulliparity), rates of LDA use increased after the updated guidelines: Medicaid insurance (as a proxy for lower income) (13.0 vs 2.0%, p< 0.001), advanced maternal age (12.4 vs 3.8%, p< 0.001), Black race (as a proxy for racism)(10.7 vs 2.7%, p< 0.001), and obesity (10.6 vs 3.6%, p< 0.001). There was no change for IVF pregnancies (6.3 vs 4.0%, p=0.19).
Conclusion:
Despite updated recommendations from USPSTF in 2021 expanding recommendations for LDA, documented use of LDA remains low. The additional single moderate risk factors associated with the lowest absolute LDA rates were Black race, obesity, and IVF pregnancy.