Antenatal aspirin prescription following the United States Preventive Services Task Force (USPSTF) 2021 practice update

BACKGROUND: The United States Preventive Services Task Force (USPSTF) recommends aspirin for patients at risk for preeclampsia, though less than 15% are correctly treated. OBJECTIVE: 1) Assess the rate of aspirin prescription for preeclampsia prophylaxis following the USPSTF's 2021 practice updates. 2) Compare the odds of aspirin prescription between patients with moderate and high risk factors for preeclampsia. STUDY DESIGN: Retrospective study of patients with prenatal care before 16w0d and delivered in our health system between 1/1- 12/31/2022. Preeclampsia risk was assigned according to 2021 USPSTF guidance. Primary outcome was aspirin prescription for preeclampsia prophylaxis, assessed using chi-square tests. Odds of correct aspirin prescription were also compared between risk groups using logistic regression. RESULTS: Of 1203 patients, 159 (13%) had 1 or more high risk and 288 (24%) had 2 or more moderate risk factors for preeclampsia. Only 246 (55%) were appropriately prescribed aspirin. Patients with 1 high risk factor were significantly more likely to be prescribed aspirin than those with multiple moderate risk factors (80% vs 42%, p < 0.001). The odds of aspirin prescription were 5 times greater among patients with at least 1 high risk factor relative to those with multiple moderate risk factors (OR 5.38, 95% CI 3.34 - 8.68; aOR 5.18, 95% CI 3.20 - 8.37). CONCLUSIONS: Only half of our patients were correctly prescribed aspirin, a trend more pronounced among those with moderate risk factors for preeclampsia. This highlights an opportunity for public health interventions and provider education regarding the benefit of aspirin in this population.