Assessment of Racial Disparities in Aspirin Prophylaxis for Preeclampsia Prevention

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

Disparities in Cardiovascular Mortality Between Black and White Adults in the United States, 1999 to 2019

“…40,62 For Black women in particular, additional funding is needed to prioritize maternal education and health advocacy during prenatal, antepartum, and postpartum periods (ie, education on risk assessment, disparities, individual cardiovascular health, routine checkups). [63][64][65] At the policy level, more initiatives are needed to protect Black men from deleterious systems that perpetuate poor cardiovascular health outcomes (ie, the criminal justice system and mass incarceration of Black men 7 ).…”

Pre‐eclampsia in low and middle‐income settings: What are the barriers to improving perinatal outcomes and evidence‐based recommendations?

“…Inadequate counseling from the health team that often does not address clearly the risks and benefits of medication use 22 Poor adherence to the uptake of aspirin by pregnant women, which is probably a consequence of inadequate counseling 23 …”

“…Considering global inequities in calcium intake, food processing techniques, which would improve calcium content in food or increase calcium availability, seem to be a very effective alternative 2,23 …”

“…22 • Poor adherence to the uptake of aspirin by pregnant women, which is probably a consequence of inadequate counseling. 23 The underuse of calcium Regarding calcium intake, populations in LMICs are at the greatest risk of low calcium intake: of the 3.5 billion people at risk of inadequate calcium intake, approximately 90% live in Africa and Asia.…”

“…27 Considering global inequities in calcium intake, food processing techniques, which would improve calcium content in food or increase calcium availability, seem to be a very effective alternative. 2,23 This review provides a broad literature review regarding preeclampsia and the challenges to overcome to improve perinatal results; however, caution is necessary to interpret the results. First, it was not a systematic review, so our results are subject to bias because they are not submitted to quality tools that guarantee greater credibility.…”