Only 11% of patients at high risk for preeclampsia are prescribed low-dose aspirin (LDA), according to a recent study by March of Dimes and Komodo Health.1
Takeaways
- Only 11% of patients at high risk for preeclampsia receive low-dose aspirin (LDA), despite recommendations from major health organizations.
- High-risk factors for preeclampsia include chronic hypertension, diabetes mellitus, multifetal gestation, renal disease, and autoimmune diseases.
- The rate of LDA prescriptions for high-risk pregnancies has increased from 6% in 2018 to 14% in 2023.
- The low prevalence of LDA prescriptions is partly because of underreporting and a lack of adherence to guidelines by healthcare providers.
- High-risk patients who received LDA had similar preeclampsia rates (25%) to those who did not (24%), suggesting the need for better monitoring and guideline adherence.
Preeclampsia, presenting as elevated blood pressure and protein in the urine, is associated with significant risks to maternal and fetal health. Complications of pregnancy linked to preeclampsia include placental abruption, preterm birth, and potential maternal and fetal mortality.
Preeclampsia, alongside other hypertensive disorders of pregnancy, has had increasing rates over time.2 Multiple risk factors increased in prevalence between 2010 and 2021, from 1.2% to 2.7% for chronic hypertension, 0.7% to 1.1% for gestational diabetes, and 14.7% to 20.1% for advanced maternal age.
Prophylactic LDA therapy after 12 weeks of pregnancy is vital for robust maternal care of preeclampsia, with this therapy recommended by the American College of Obstetricians and Gynecologists, World Health Organization, and US Preventive Services Task Force.1 LDA therapy has been linked to a 10% to 20% reduction in preeclampsia risk.
An analysis was conducted to determine the prevalence of LDA use among patients at a high risk of preeclampsia. Data was obtained from Komodo’s Healthcare Map, a comprehensive database of US patient journeys. Recorded birth events from January 2018 to December 2023 were assessed for prescriptions, risk levels, and diagnoses.1
High-risk preeclampsia was determined based on preeclampsia history, chronic hypertension, multifetal gestation, renal disease, diabetes mellitus, and autoimmune disease. The presence of any of these factors up to 280 days before birth indicated high risk. Using these criteria, 1.5 million high-risk births were identified.
LDA prescription among high-risk women was determined by the presence of at least 1 LDA prescription up to 280 days before birth. Birth outcomes evaluated included preeclampsia, cesarean delivery, and vaginal delivery.
There were 15.3 million qualifying births, 10% of which were at high risk for preeclampsia and 5% developed the condition. A record of LDA prescription during pregnancy was only reported in 11% of high-risk patients, with 89% having no record of an LDA prescription.1
These rates may be explained in part by undercapturing caused by low billing and high rates of over-the-counter LDA purchases. However, a lack of guideline adherence is likely also responsible for the low prevalence of LDA prescription during a high-risk pregnancy. Over 2% of non-high-risk births had a documented LDA prescription during pregnancy.
An increase has been observed in formal LDA prescription over time, from 6% in 2018 to 14% in 2023 among high-risk pregnancies. This indicates a rise of 8%. Additionally, non-high-risk pregnancies had an increase in LDA prescriptions by over 3%, from 1% in 2019 to 5% in 2023.1
Currently, it is unclear whether improvements in reporting or increases in the number of high-risk patients are reflected by this increase in prescriptions. It is also unclear whether an adherence in guidelines has contributed to this trend.
Regardless of prescription status, approximately 1 in 4 high-risk patients developed preeclampsia, at 25% among those with LDA prescriptions vs 24% among those without LDA prescriptions. However, these rates were likely impacted by the proportion of patients with a prescription receiving over-the-counter LDA.
Preeclampsia was reported in 3% of non-high-risk patients. The difference in preeclampsia development based on LDA prescription status was greater in this group, at 7% in those with a prescription and 3% in those without a prescription.1
Notable figures included a 72% increased risk of cesarean section among patients at high risk of preeclampsia vs those not at high risk. The risk of preterm birth was also increased 2-fold in these patients. Finally, the odds of being classified as high risk were increased by 49% among Black patients vs White patients.
This data highlights the need to improve monitoring of LDA in pregnancies at high risk of preeclampsia. Investigators concluded physicians should be encouraged to record prescriptions for LDA even when the patient plans to purchase it independently.1
Reference
- Khan T, Kim C, Druet A, Rouse S, Stoneburner A. A hidden shield: Addressing the underutilized — and underreported — potential of low-dose aspirin (LDA) in preeclampsia prevention. July 30, 2024. Accessed August 1, 2024. https://www.komodohealth.com/hubfs/_2024/LDA_Utilization_in_Pregnancy_Research_Brief.pdf
- Krewson C. Rising prevalence of hypertensive disorders of pregnancy reported. Contemporary OB/GYN. June 10, 2024. Accessed August 1, 2024. https://www.contemporaryobgyn.net/view/rising-prevalence-of-hypertensive-disorders-of-pregnancy-reported
