(314) Pilot Study to Assess Non-Adherence to Daily Low Dose Aspirin in Patients with Pregestational Diabetes

Objective: Daily low-dose 81mg aspirin (LDASA) is recommended for those with pregestational diabetes to reduce risk for hypertensive disorders of pregnancy (HDP). High adherence to daily dosing is necessary to achieve prophylactic benefit. We investigated the non-adherence rate of daily LDASA in gravidas with pregestational diabetes at 28 and 36 weeks gestational age (GA) to determine if an intervention is needed to improve adherence.

Study Design: This was a prospective cohort study performed between 1/2022 and 7/2023 of gravidas with type 1 (T1DM) or 2 diabetes (T2DM) enrolled at 12-24 weeks GA. Participants were recommended LDASA per standard of care. Adherence was surveyed using the validated simplified medication adherence questionnaire (SMAQ) at 28 and 36 weeks. Non-adherence was defined as responding “yes” to any survey question or reporting more than two missed doses in the past week or past three months. Demographic and pregnancy data were collected. Univariate analysis was performed utilizing Stata.

Results: Seventy-one participants were enrolled in the study, with a mean age of 31.2±5.0 years and mean GA 15.7±3.96 weeks. The majority had T2DM (77.5% (55/71)) and 22.5% (16/71) had T1DM.  Most of the cohort (69% (49/71)) identified as Latinx and 82.6% (57/71) spoke English as a primary language. Of the 58 participants who completed the SMAQ either at 28 or 36 weeks, 40 (69.0%) demonstrated non-adherence to daily low dose aspirin at one or both time points (62.3% at 28 weeks and 69.0% at 36 weeks). This was significantly greater than the expected literature rate of 45% (p=0.0002). Non-adherence did not differ by diabetes type, insulin use or any other demographic factor. The rate of HDP in the delivered participants in this cohort was 48.9% and did not differ by LDASA adherence.

Conclusion: In this population of gravidas with diabetes at high risk of HDP who were recommended LDASA, 69% were non-adherent by self-report through SMAQ, which is far higher than expected. A strong intervention is needed to improve adherence to optimize HDP risk reduction in this population.