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• W4310668712 abstract "In patients with risk factors for preeclampsia, low-dose aspirin prophylaxis is recommended to reduce the risk for preeclampsia.1ACOG Committee Opinion number 743: Low-dose aspirin use during pregnancy.Obstet Gynecol. 2018; 132: e44-e52Crossref PubMed Scopus (317) Google Scholar,2Davidson K.W. Barry M.J. et al.US Preventive Services Task ForceAspirin use to prevent preeclampsia and related morbidity and mortality: US Preventive Services Task Force Recommendation Statement.JAMA. 2021; 326: 1186-1191Crossref PubMed Scopus (93) Google Scholar However, low-dose aspirin has been underutilized. For example, a recent study reported that only 58% of patients with high-risk factors and <5% of patients with ≥2 moderate-risk factors reported using low-dose aspirin.3Olson D.N. Russell T. Ranzini A.C. Assessment of adherence to aspirin for preeclampsia prophylaxis and reasons for nonadherence.Am J Obstet Gynecol MFM. 2022; 4100663Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar One reason for low utilization may be that the list of risk factors is long, so reliance on memory to screen for risk factors may be ineffective. The Society for Maternal-Fetal Medicine (SMFM) proposed that a risk factor checklist might improve screening.4Combs C.A. Montgomery D.M. SMFM Patient Safety and Quality Committee. Electronic address: [email protected]Society for Maternal-Fetal Medicine special statement: checklists for preeclampsia risk-factor screening to guide recommendations for prophylactic low-dose aspirin.Am J Obstet Gynecol. 2020; 223: B7-B11Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar We sought to evaluate whether routine use of a checklist is associated with higher rates of low-dose aspirin use in patients with risk factors. This was a retrospective cohort study of patients referred for an ultrasound examination at our maternal-fetal medicine practice. At their first visit, patients were asked to complete a preeclampsia risk-factor screening checklist questionnaire similar to the SMFM patient-completed checklist.4Combs C.A. Montgomery D.M. SMFM Patient Safety and Quality Committee. Electronic address: [email protected]Society for Maternal-Fetal Medicine special statement: checklists for preeclampsia risk-factor screening to guide recommendations for prophylactic low-dose aspirin.Am J Obstet Gynecol. 2020; 223: B7-B11Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar The cohort comprised consecutive patients with an initial ultrasound visit from October 2020 through to March 2021.5Combs C.A. Zhou M.K. Pandipati S. Del Rosario A.D. Prevalence of preeclampsia risk factors: implications for low-dose aspirin prophylaxis.Am J Obstet Gynecol MFM. 2022; 4: 100547Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar The local institutional review board classified the study as exempt. This study included a subset with gestational ages of 120/7 through 276/7 weeks, the recommended range for initiation of low-dose aspirin. Before and during the study period, a group of referring obstetricians routinely administered the same checklist at the initial prenatal visit before referral to our office. We compared the rate of self-reported use of low-dose aspirin in patients referred by that specific provider group vs the rate of use among patients referred by other providers. The questionnaire was completed by 2056 of 2098 patients (98.0%), of which 1907 were between 120/7 and 276/7 weeks of gestation. Of these, 421 (22.1%) were from the practice group that routinely used the checklist. Patients from that group reported higher rates of low-dose aspirin use than patients from other providers (Table). Among patients with any high-risk factor, the rates of low-dose aspirin use were 78% among those from the specific practice group vs 52% among those referred by other providers (P<.001). Among patients with ≥2 moderate-risk factors, the rates were 68% and 22%, respectively (P<.001). Among patients with any indication for low-dose aspirin prophylaxis the rates were 71% vs 31%, respectively (P<.001). These differences persisted after adjustment for baseline between-group differences in risk factor prevalence (Supplemental Tables 1 and 2). The odds ratio for use of low-dose aspirin was 3.26 (95% confidence interval [CI], 1.60–6.64) among patients with any high-risk factor; 5.80 (95% CI, 3.51–9.60] among patients with ≥2 moderate-risk factors; and 4.52 (95% CI, 3.03–6.72) among patients with any indication for low-dose aspirin prophylaxis.TablePercentage of patients reporting low-dose aspirin useRisk factorPatients from group using checklist (n=421)Patients from other providers (n=1486)Risk ratio (95% CI)P valueaP values were determined using chi-square testsHigh-risk History of preeclampsia17/22 (77%)29/52 (56%)1.38 (0.99–1.93).08 Chronic hypertension17/18 (94%)56/87 (64%)1.45 (1.21–1.78).01 Multifetal pregnancy6/9 (67%)9/25 (36%)1.81 (0.92–3.72).13 Diabetes mellitus (type 1 or 2)6/9 (67%)13/28 (46%)1.44 (0.78–2.64).44 Autoimmune disorder9/10 (90%)4/16 (25%)3.60 (1.50–8.62).001Moderate-risk (in combination with any other risk factor[s]) Nulliparity64/91 (70%)103/329 (31%)2.25 (1.82–2.77)<.001 Obesity37/43 (86%)73/216 (34%)2.55 (2.04–3.18)<.001 Preeclampsia in mother or sister16/20 (80%)19/47 (40%)1.99 (1.31–2.98).003 African ancestry5/6 (83%)9/24 (38%)2.22 (1.19–4.17).07 Medicaid or self-paybSurrogate for low socioeconomic status, which was not on checklist. Derived from patient chart1/1 (100%)24/159 (15%)6.63 (4.58–9.58).15 Maternal age ≥35 y75/103 (73%)109/285 (38%)1.90 (1.58–2.30)<.001 Patient had low birthweight9/14 (64%)12/70 (17%)3.75 (1.96–7.16)<.001 Previous child low birthweight10/17 (59%)18/60 (30%)1.96 (1.12–3.41).04 ≥10 years since most recent pregnancy9/15 (60%)18/73 (25%)2.43 (1.37–4.33).01 In vitro fertilization18/24 (75%)35/61 (57%)1.31 (0.95–1.79).13 Abnormal serum analytes1/1 (100%)2/6 (33%)3.00 (0.97–9.30).21Number of risk factors No risk factors2/62 (3%)5/225 (2%)1.45 (0.29–7.30).47 1 moderate, 0 high-risk factors28/191 (15%)39/660 (6%)2.48 (1.57–3.92)<.001 ≥2 moderate, 0 high-risk factors74/110 (67%)97/431 (23%)2.92 (2.34–3.63)<.001 ≥1 high, with or without moderate-risk factors45/58 (78%)89/170 (52%)1.48 (1.21–1.81)<.001 Any indication for low-dose aspirin usecIndications include any high-risk factor(s) or ≥2 moderate-risk factors (per ACOG,1 2018).119/168 (71%)186/601 (31%)2.29 (1.96–2.67)<.001Data are presented as number (percentage) or risk ratio (95% CI).CI, confidence interval.Zhou. Preeclampsia risk factor checklist. Am J Obstet Gynecol 2023.a P values were determined using chi-square testsb Surrogate for low socioeconomic status, which was not on checklist. Derived from patient chartc Indications include any high-risk factor(s) or ≥2 moderate-risk factors (per ACOG,1ACOG Committee Opinion number 743: Low-dose aspirin use during pregnancy.Obstet Gynecol. 2018; 132: e44-e52Crossref PubMed Scopus (317) Google Scholar 2018). Open table in a new tab Data are presented as number (percentage) or risk ratio (95% CI). CI, confidence interval. Zhou. Preeclampsia risk factor checklist. Am J Obstet Gynecol 2023. Routine use of a checklist to screen for preeclampsia risk factors at the first prenatal visit was associated with significantly higher rates of low-dose aspirin use in patients at risk for preeclampsia. We recommend routine use of a checklist to identify maternal risk factors that identify candidates for low-dose aspirin prophylaxis. The SMFM has published several other patient safety checklists (eg, for cesarean delivery, operative delivery, and diabetes mellitus antepartum care). Future research should assess whether their use improves outcomes." @default.
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• W4310668712 date "2023-03-01" @default.
• W4310668712 modified "2023-10-18" @default.
• W4310668712 title "Association of checklist usage with adherence to recommended prophylactic low-dose aspirin for prevention of preeclampsia" @default.
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