Key result
Risk-based counseling for pregnant women with increased preeclampsia risk was associated with higher low-dose aspirin usage compared to care-as-usual.
Why the study?
Evidence on low-dose aspirin adherence during pregnancy is primarily from clinical trials, potentially introducing bias, and determinant data are lacking.
Does risk-based counseling increase low-dose aspirin usage in pregnant women with an increased preeclampsia risk?
Cohort (n=3,479)
Yes
Does risk-based counseling increase low-dose aspirin usage in pregnant women with an increased preeclampsia risk?
Risk-based counseling significantly increases the use of prophylactic low-dose aspirin among pregnant women at high risk for preeclampsia, although overall adherence rates remain suboptimal.
Answers are grounded in this paper and cite their sources.
May boost aspirin uptake in high-risk pregnancies via counseling; leaves open preeclampsia prevention effects pending trials.
INTRODUCTION: Low-dose aspirin (LDA) prophylaxis has been shown to reduce women's preeclampsia risk. Evidence regarding LDA adherence rates of pregnant women is based almost exclusively on clinical trials, giving a potentially biased picture. Moreover, these studies do not report on determinants of adherence. Since 2017, obstetric healthcare professionals in a Dutch region have assessed women's preeclampsia risk by means of a prediction tool and counseled those with an above-population average risk on LDA as a prophylactic measure. MATERIAL AND METHODS: From 2017 to 2018, 865 women were recruited in multiple centers and prospectively followed using web-based surveys (Expect Study II). Rates and determinants of LDA usage among women with an increased preeclampsia risk in daily practice were assessed. Results were compared with findings in a similar cohort from a care-as-usual setting lacking risk-based counseling (Expect Study I, n = 2614). Netherlands Trial Register NTR4143. RESULTS: In total, 306 women had a predicted increased preeclampsia risk. LDA usage was higher for women receiving risk-based care than care-as-usual (29.4% vs 1.5%, odds ratio 19.1, 95% confidence interval 11.2-32.5). Daily LDA usage was positively correlated with both predicted risk and women's concerns regarding preeclampsia. Most reported reasons for non- or incomplete use were unawareness of LDA as a preventive intervention, concerns about potential adverse effects and doubts regarding the benefits. CONCLUSIONS: Risk-based counseling was associated with a higher prevalence of LDA usage, but general usage rates were low. Future research regarding potential factors improving the usage of LDA during pregnancy is necessary.
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Montfort et al. (2020) conducted a cohort in Increased preeclampsia risk (n=3,479). Risk-based counseling on low-dose aspirin vs. Care-as-usual lacking risk-based counseling was evaluated on Low-dose aspirin usage (OR 19.1, 95% CI 11.2-32.5). Risk-based counseling for pregnant women with increased preeclampsia risk was associated with higher low-dose aspirin usage compared to care-as-usual.
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