(527) Differences in LDASA initiation for preeclampsia prevention in at-risk pregnancies between White and non-White patients

The Society for Maternal Fetal Medicine (SMFM) and the US Preventive Services Task Force recommend low-dose aspirin (LDASA) for preeclampsia (PEC) risk reduction in at-risk pregnancies. Current evidence suggests inconsistent prescribing practices for at risk patients. SMFM developed a checklist to make these practices more uniform. We sought to understand if LDASA prescribing practices for at risk patients differed between White and non-White patients at our institution.

Study Design:

We launched a PEC risk screen and LDASA eligibility smart-phrase modeled after SMFM checklist within the electronic medical record for use by all prenatal care providers. A retrospective chart review was performed to identify all patients who would be candidates for LDASA during their pregnancy between December 2022 and May 2023 to assess differences in prescribing practices by patient self-identified race.

Results:

714 LDASA eligible patients with documented self-identified race were identified. Overall, 57.8% (413/714) were prescribed LDASA. 12.9% (92/714) self-identified as Asian, with 58.7% (54/92) prescribed LDASA. 21.6% (154/714) as Black, with 41.6% (64/154) prescribed LDASA. 28.6% (204/714) as Hispanic, with 68.1% (139/204) prescribed LDASA. 2.1% (21/714) identified as Multiracial, with 57.1% (12/21) prescribed LDASA. 34% (243/714) identified as White, with 59.3% (144/243) prescribed LDASA. Logistic regression was used to analyze the relationship between patient race and LDASA use. Black patients were 52% (P< .001) less likely than White patients to be given LDASA (OR 0.489, 95% CI [.32 - .73]). Though not statistically significant, Hispanic patients were 47% (P=0.53) more likely than White patients to be given LDASA (OR 1.47, 95% CI [.995 - 2.17]). No statistical difference in LDASA use was found between White patients, Asian and Multiracial patients.

Conclusion:

Over 40% of patients with known risk factors for PEC were not prescribed LDASA during pregnancy. Black patients were less likely to be prescribed LDASA than White patients. Further work is needed to improve disparities in LDASA prescribing practices.