Adherence to aspirin use during pregnancy among women at risk of preeclampsia: A cross‐sectional study

INTRODUCTION: Aspirin prevents severe preeclampsia, but its effectiveness depends on its use. Aspirin is recommended in pregnancy for women at risk of preeclampsia. However, evidence on prophylactic aspirin uptake and adherence is limited. The aim was to examine whether women at risk received recommendations to use aspirin and estimate the prevalence of inadequate adherence. MATERIAL AND METHODS: Cross-sectional internet survey conducted in Iceland. Pregnancies were classified as low, moderate, and high risk for preeclampsia according to guidelines. The Morisky-Medicine-Adherence-Scale© (MMAS-8) was used to estimate adherence, classified as good (8 points), moderate (6-7.9), and inadequate (<6). Prevalence ratios (PR) for inadequate adherence were calculated with 95% confidence intervals (CI), with the high-risk group as reference. RESULTS: Survey responses were received from 887 women with gestational age between 12 + 0 and 36+ 6, with 122 at high and 137 at moderate preeclampsia risk. In total, 229 women reported being recommended aspirin: 87 at high risk (71%), 92 at moderate risk (67%), and 50 at low risk (8%). Nonadherence was reported by 13 women (5.7%). The prevalence of inadequate adherence was 25% among high-risk, 21% among moderate-risk (PR 0.83; 95% CI: 0.47-1.46), and 27% among low-risk respondents. No individual risk factors were significantly associated with inadequate adherence. CONCLUSIONS: Respondents at risk of preeclampsia commonly did not remember receiving appropriate recommendations for aspirin. This may considerably limit the effectiveness of screening and aspirin prevention in Iceland, and a more systematic approach could be needed. However, adherence to aspirin in our population was comparable to previously reported adherence to medication for chronic illnesses and not related to risk status.