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Am J Perinatol 2024; 41(05): 635-640
DOI: 10.1055/s-0042-1743142
Original Article

Assessment of Racial Disparities in Aspirin Prophylaxis for Preeclampsia Prevention

Nina W. Ragunanthan
1   Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Jordan Lamb
2   University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Alisse Hauspurg
1   Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Stacy Beck
1   Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
› Author Affiliations Funding This work was supported by NIH/ORWH Building Interdisciplinary Research Careers in Women's Health (BIRCWH) NIH K12HD043441 scholar funds to AH.
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Abstract

Objective Low-dose aspirin is recommended for preeclampsia prevention among women with high-risk conditions, including chronic hypertension. Black women have higher rates of hypertensive disorders of pregnancy, and whether this is related to disparities in aspirin prophylaxis is unknown. We investigated the relationship between race and counseling/prescription and uptake of aspirin among a cohort of women with chronic hypertension.

Study Design This is a single-institution, retrospective cohort study of women with chronic hypertension who delivered between 2016 and 2018. Medical record review was performed to assess counseling/prescription of aspirin prophylaxis and self-reported uptake. Self-reported uptake was determined by mention in the provider's notes or by inclusion in the medication reconciliation system. Demographic and obstetric outcome data were compared by self-reported race (Black vs. all other races) in univariate analysis. Multivariable logistic regression analysis was performed to evaluate the association between race and aspirin adherence.

Results We included 872 women: 361 (41.4%) Black women and 511 (58.6%) white or other race women. Overall, 567 (65.0%) women were counseled and/or given a prescription for aspirin, and 411 (72.4%) of those women reported uptake. Black women were equally likely to be counseled and/or prescribed aspirin compared with all other races (67.3 vs. 63.4%; p = 0.7). However, Black women were less likely to report uptake of aspirin (63.8 vs. 79.0%; p < 0.001). After adjustment for total prenatal visits and tobacco use, Black race was associated with an adjusted odds ratio of 0.53 (95% confidence interval: 0.36–0.78) for uptake of aspirin.

Conclusion In our cohort, recommendation for aspirin prophylaxis was suboptimal in all groups, reaching only 65% of eligible women. Black women were equally likely as women of other races to receive counseling about aspirin, but rates of uptake were lower. Our findings suggest that counseling and prescription of aspirin alone in high-risk Black women are not sufficient for utilization of this intervention.

Key Points

  • Rates of counseling about aspirin prophylaxis for preeclampsia did not vary by race.

  • Black women had lower rates of uptake of aspirin compared with women of other races.

  • Counseling about aspirin was inadequate in general, reaching only 65% of eligible women.

Keywords

preeclampsia - aspirin - racial disparities - medication uptake

Note

The findings from this research were presented at the Society of Maternal Fetal Medicine's 40th Annual Pregnancy Meeting, February 3 to 8, 2020 in Grapevine, Texas and at the ACOG Annual Clinical and Scientific Meeting April 24 to 27, 2020 in Seattle, Washington (virtual poster; in-person meeting cancelled secondary to COVID-19).


Supplementary Material



Publication History

Received: 23 March 2021

Accepted: 17 January 2022

Article published online:
21 February 2022

© 2022. Thieme. All rights reserved.

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