The research team reviewed and included a total of 523 charts in the analysis. Table 1 presents demographic information about the patients. The largest race/ethnicity group in our sample was Hispanic (40.2%), followed by Black/African American (27.9%), non-Hispanic White (25%), and Other (6.9%). Our sample was relatively evenly distributed across age groups, with 23.5% aged 18-24, 56% aged 25-34, and 20.5% aged 35 or older. The majority of individuals utilized Medicaid insurance (80.3%), while 18.93% utilized commercial insurance; a small percentage utilized Medicare or dual Medicare Medicaid insurance (0.38%). During the study period, 78.78% of individuals did not receive aspirin, while 21.22% were prescribed low-dose aspirin.
TABLE 1: DEMOGRAPHICS
|
Race/Ethnicity
|
N
|
%
|
Non-Hispanic White
|
131
|
25.0
|
Non-Hispanic Black/African American
|
146
|
27.9
|
Hispanic
|
210
|
40.2
|
Other
|
36
|
6.9
|
Age Groups
|
|
|
18-24
|
123
|
23.5
|
25-34
|
293
|
56.0
|
35+
|
107
|
20.5
|
Current Insurance Status
|
|
|
Commercial
|
99
|
18.93
|
Medicare
|
2
|
.38
|
Medicaid
|
420
|
80.3
|
Dual Medicare Medicaid
|
2
|
.38
|
Aspirin
|
|
|
No ASA
|
412
|
78.78
|
ASA
|
111
|
21.22
|
Table 2 demonstrates aspirin prescribing by risk category. Of the 523 total patients in this study, 249 (47.6%) were classified as being at increased risk for developing preeclampsia and eligible for low-dose aspirin per ACOG guidelines. Two or moderate risk factors were present in 154 (29.44%) patients and at least one high-risk factor was present in 95 (18.16%) patients. More than half (57.89%, OR 9.13, CI 5.56-14.98, p<0.001) of patients with any high risk factor received aspirin, while only 27.27% (OR 1.63, CI 1.04-2.53, p=0.03) of patients with 2 or more moderate risk factors without high risk factors were prescribed aspirin.
TABLE 2: ASPIRIN PRESCRIBING BY RISK CATEGORY
Risk Factor
|
n
(N=523)
|
% No ASA Rx
|
% ASA Rx
|
unadj OR
|
95% CI
|
p value
Tar
|
Any High Risk
|
95
|
42.11
|
57.89
|
9.13
|
5.56, 14.98
|
<0.001
|
Two or more Moderate Risk Factors, no high-risk factors
|
154
|
72.73
|
27.27
|
1.63
|
1.04, 2.53
|
0.03
|
Total combined risk pool appropriate for prescribing
|
249
|
61.04
|
38.96
|
11.85
|
6.53, 21.48
|
<0.001
|
Table 3 presents preeclampsia risk factors and their association with low-dose aspirin prescribing during pregnancy, unadjusted and adjusted for other risk factors. Within the unadjusted model, four moderate risk factors were significantly associated with aspirin prescribing, including AMA (OR 2.05, CI 1.27-3.301, p=0.003), Black “race” (OR 2.63, CI 1.71-4.04, p<0.001), family hx PEC (OR 7.66, CI 1.38-42.399, p=0.02), and nulliparity (OR 2.3, CI 1.33-3.99, p=0.003). Significant high risk factors within the unadjusted model were history of preeclampsia (OR 14.56, CI 6.6-32.1, p<0.001), history of hypertension (OR 17.908, CI 7.52-42.6, p<0.001), and history of diabetes (OR 3.24, CI 1.31-8.05, p=0.011). In the adjusted model, AMA (aOR 2.79, CI 1.51-5.17, p=0.001), Black “race” (aOR 2.52, CI 1.48-4.28, p=0.001), nulliparity (aOR 2.9, CI 1.46-5.76, p=0.002), history of preeclampsia (aOR 20.81, CI 8.51-50.87, p<0.001), and history of hypertension (aOR 13.57, CI 5.05-36.49, p<0.001) remained significantly associated with aspirin prescribing.
TABLE 3: ASPIRIN PRESCRIBING BY PREECLAMPSIA RISK FACTORS
|
|
|
ASA at any time during pregnancy
Unadjusted for other RF
n=523
|
ASA at any time during pregnancy
adjusted for other RF
n=523
|
|
Risk Factor
|
n
|
% No ASA Rx
|
% ASA Rx
|
unadj OR
|
95% CI
|
p value
|
adj OR
|
95% CI
|
p value
|
High Risk
|
Hx Preeclampsia
|
36
|
25
|
75
|
14.56
|
6.6, 32.11
|
<0.001
|
20.81
|
8.51, 50.87
|
<0.001
|
|
Hx Hypertension
|
33
|
21.21
|
78.79
|
17.908
|
7.52, 42.61
|
<0.001
|
13.57
|
5.05, 36.49
|
<0.001
|
|
History Diabetes
|
20
|
55
|
45
|
3.24
|
1.31, 8.05
|
0.011
|
1.69
|
.51, 5.54
|
0.385
|
|
History CKD
|
2
|
100
|
0
|
omit
|
|
|
omit
|
|
|
|
History Autoimmune
|
14
|
78.57
|
21.43
|
1.02
|
.28, 3.72
|
0.974
|
0.97
|
.186, 5.04
|
0.972
|
|
Multifetal gestation
|
7
|
71.43
|
28.57
|
1.52
|
.291, 7.95
|
0.619
|
3.18
|
.534, 18.99
|
0.204
|
Mod. Risk
|
Advanced Maternal Age (AMA)
|
107
|
68.22
|
31.78
|
2.05
|
1.27, 3.301
|
0.003
|
2.79
|
1.51, 5.17
|
0.001
|
Black “race”
|
167
|
67.07
|
32.93
|
2.63
|
1.71, 4.04
|
<0.001
|
2.52
|
1.48, 4.28
|
0.001
|
Obesity
|
257
|
76.26
|
23.74
|
1.344
|
.882, 2.04
|
0.168
|
1.1
|
.663, 1.84
|
0.701
|
Family hx PEC
|
6
|
33.33
|
66.67
|
7.66
|
1.38, 42.399
|
0.02
|
5.49
|
.797, 37.81
|
0.084
|
interval 10
|
22
|
68.18
|
31.82
|
1.78
|
.707,4.48
|
0.22
|
2.73
|
.983, 7.60
|
0.054
|
Nullip
|
68
|
64.71
|
35.29
|
2.307
|
1.33, 3.99
|
0.003
|
2.9
|
1.46, 5.76
|
0.002
|
Table 4 shows a cross tabulation of the percentage of patients with more than one risk factor per ACOG guidelines who received aspirin through the clinical course of their pregnancy episode. Only risk-factors with statistically significant odds associated with aspirin prescribing in the logistic models were included in the cross-tabulation.
Amongst high risk factors, the data show that 75% of patients with a history of preeclampsia were prescribed aspirin, whether they had any additional risk factors or not. Patients with both a history of preeclampsia and a history of hypertension received aspirin 87.5% of the time. Similarly, 45% of patients with diabetes were prescribed aspirin, but when combined with a history of hypertension, 100% of eligible patients received aspirin.
Amongst moderate risk factor combinations, AMA and obesity (27.12%), Black “race” and obesity (32.14%), and Black “race” and AMA (48.39%) were the risk profiles that had the lowest rates of appropriately prescribed aspirin for eligible patients. When these individual moderate risk factors were combined with a high risk factor, the proportion of patients prescribed aspirin increased.
TABLE 4: PROPORTION OF ASPIRIN PRESCRIBING BY RISK FACTOR COMBINATION
Risk Factor
|
High Risk Factors
|
Moderate Risk Factors
|
% Aspirin Prescribing Based on Combination of Risk Factors
|
History Preeclampsia
|
History Hypertension
|
History Diabetes
|
Advanced Maternal Age
|
Black/ African American
|
Obesity
|
History Preeclampsia
|
75
|
87.50
|
50.00
|
66.67
|
93.33
|
83.33
|
History Hypertension
|
|
71.43
|
100
|
77.78
|
89.47
|
77.78
|
History Diabetes
|
|
|
45
|
45.45
|
83.33
|
57.14
|
Advanced Maternal Age
|
|
|
|
31.78
|
48.39
|
27.12
|
Black/African American
|
|
|
|
|
32.93
|
32.14
|
Obesity
|
|
|
|
|
|
23.74
|