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Factors Associated with Guideline Concordant Clinician Counseling about Low-Dose Aspirin to Prevent Preeclampsia in Nulliparous Patients.

Publication ,  Journal Article
Myers, SO; Luke, S; Ramey-Collier, KL; Truong, T; Weaver, K; Swamy, GK; Wheeler, SM
Published in: Am J Perinatol
July 4, 2023

OBJECTIVE:  The primary aim of this study was to examine the United States Preventative Services Task Force (USPSTF) guidelines concordant low-dose aspirin (LDA) counseling and factors associated with counseling in nulliparous birthing individuals. STUDY DESIGN:  We conducted a retrospective cohort study of nulliparous birthing individuals who delivered between January 1, 2019 and June 30, 2020 and received prenatal care at the Duke High Risk Obstetrical Clinics (HROB). All nulliparous patients over 18 years old who established or transferred care to HROB by 16 weeks, 6 days were included in the analysis. We excluded patients with more than two previous first-trimester pregnancy losses, multiple gestation, a known contraindication to LDA, initiation of LDA prior to their prenatal care, or documented medical history of coagulation disorder. Bivariate associations between demographic/medical characteristics and our primary outcome, receipt of counseling (yes/no), were assessed using two-sample t-tests for continuous variables and chi-square or Fisher's exact test for categorical variables. Factors significantly associated with the primary outcome (p < 0.05) were entered into the multivariable logistic regression model. RESULTS:  Among 391 birthing individuals included in the final analysis cohort, 51.7% of eligible patients received guideline consistent LDA counseling. Factors associated with increased odds of LDA counseling were advanced maternal age (adjusted odds ratio [aOR]: 1.05, 95% confidence interval [CI]: 1.01-1.09), Black race compared with White race (aOR:1.75, 95% CI: 1.03-2.98), chronic hypertension (aOR: 4.17, 95% CI: 1.82-9.55), and obesity (aOR: 5.02, 95% CI: 3.12-8.08). CONCLUSION:  Approximately half of all nulliparous birthing individuals had appropriately documented LDA counseling. The USPSTF guidelines on LDA for preeclampsia risk reduction are complex, which may lead to ineffective provider adherence. Efforts to simplify guidelines and improve LDA counseling are vital to ensuring this low-cost, evidence-based preeclampsia prevention is used in a consistent and equitable manner. KEY POINTS: · A total of 51.7% of eligible patients received guideline consistent LDA counseling.. · Advanced maternal age , body mass index > 30, Black race, and chronic hypertension associated with increased odds of counseling.. · Among patients most likely to be counseled, high numbers did not receive LDA counseling..

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Published In

Am J Perinatol

DOI

EISSN

1098-8785

Publication Date

July 4, 2023

Location

United States

Related Subject Headings

  • Obstetrics & Reproductive Medicine
  • 4204 Midwifery
  • 3215 Reproductive medicine
  • 3213 Paediatrics
  • 1114 Paediatrics and Reproductive Medicine
  • 1103 Clinical Sciences
 

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Myers, S. O., Luke, S., Ramey-Collier, K. L., Truong, T., Weaver, K., Swamy, G. K., & Wheeler, S. M. (2023). Factors Associated with Guideline Concordant Clinician Counseling about Low-Dose Aspirin to Prevent Preeclampsia in Nulliparous Patients. Am J Perinatol. https://doi.org/10.1055/a-2096-3466
Myers, Sabrena O., Shauntell Luke, Khaila L. Ramey-Collier, Tracy Truong, Kristin Weaver, Geeta K. Swamy, and Sarahn M. Wheeler. “Factors Associated with Guideline Concordant Clinician Counseling about Low-Dose Aspirin to Prevent Preeclampsia in Nulliparous Patients.Am J Perinatol, July 4, 2023. https://doi.org/10.1055/a-2096-3466.
Myers SO, Luke S, Ramey-Collier KL, Truong T, Weaver K, Swamy GK, et al. Factors Associated with Guideline Concordant Clinician Counseling about Low-Dose Aspirin to Prevent Preeclampsia in Nulliparous Patients. Am J Perinatol. 2023 Jul 4;
Myers, Sabrena O., et al. “Factors Associated with Guideline Concordant Clinician Counseling about Low-Dose Aspirin to Prevent Preeclampsia in Nulliparous Patients.Am J Perinatol, July 2023. Pubmed, doi:10.1055/a-2096-3466.
Myers SO, Luke S, Ramey-Collier KL, Truong T, Weaver K, Swamy GK, Wheeler SM. Factors Associated with Guideline Concordant Clinician Counseling about Low-Dose Aspirin to Prevent Preeclampsia in Nulliparous Patients. Am J Perinatol. 2023 Jul 4;
Journal cover image

Published In

Am J Perinatol

DOI

EISSN

1098-8785

Publication Date

July 4, 2023

Location

United States

Related Subject Headings

  • Obstetrics & Reproductive Medicine
  • 4204 Midwifery
  • 3215 Reproductive medicine
  • 3213 Paediatrics
  • 1114 Paediatrics and Reproductive Medicine
  • 1103 Clinical Sciences