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Clinical Obstetrics

Poster Session 2

(486) Compliance with national guidelines for aspirin prophylaxis for preeclampsia prevention

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary & Presenting Author(s)

  • Bhavana Janga, MD (she/her/hers)

    Resident
    MetroHealth Medical Center, Case Western Reserve University
    Cleveland, OH, United States

    • Coauthor(s)

  • HH

    Hannah Hill, MS

    MetroHealth Medical Center, Population Health and Equity Research Institute
    Cleveland, OH, United States

  • GL

    Gabriel Labbad, MD

    Cedars-Sinai Health System
    Los Angeles, CA, United States

  • AR

    Angela Ranzini, MD

    MetroHealth Medical Center, Case Western Reserve University
    Cleveland, OH, United States

Objective: Since 2014, the American College of Obstetricians and Gynecologists (ACOG) has recommended aspirin prophylaxis, beginning at 12 weeks gestational age, to prevent preterm preeclampsia in high-risk patients. Despite the known benefits of aspirin prophylaxis, the frequency of provider adherence to this recommendation is poorly understood. Hence, we assessed the frequency of guideline adherence over time and the risk factors for non-adherence.

Study Design:

From 2012-2023, 29,595 patients received prenatal care at our tertiary care center. Patients that met the criteria for aspirin prophylaxis were identified, and longitudinal adherence to guidelines was assessed. We then evaluated patient factors contributing to guideline non-adherence.

Results:

A total of 10,171 (34%) patients met the criteria for aspirin prophylaxis. Of those eligible, 1,463 (14%) were prescribed aspirin prophylaxis overall. Guideline adherence improved with time, increasing from 2.7% of eligible patients in 2014 to 26% in 2022 (Figure 1). Since the inclusion of moderate risk factors in the guidelines, eligible patients most often overlooked were a combination of Black race and low income, comprising 47% of eligible patients that did not receive a prescription.

Conclusion:

Despite the ACOG recommendation for aspirin prophylaxis for the prevention of preterm preeclampsia, only 26% of eligible present-day patients received a prescription. Low-income Black patients were most frequently overlooked, suggesting that populations already at increased risk are being left out. Alternate methods to encourage guideline adherence, such as a provider alert, are needed to facilitate the benefit of evidence-based recommendations.