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Multicenter Study
. 2020 Jul;99(7):875-883.
doi: 10.1111/aogs.13808. Epub 2020 Jan 31.

Low-dose-aspirin usage among women with an increased preeclampsia risk: A prospective cohort study

Pim van Montfort  1 , Hubertina C J Scheepers  2 , Ivo M A van Dooren  3 , Linda J E Meertens  1 , Maartje Zelis  4 , Iris M Zwaan  5 , Marc E A Spaanderman  2 , Luc J M Smits  1
Affiliations
Multicenter Study

Low-dose-aspirin usage among women with an increased preeclampsia risk: A prospective cohort study

Pim van Montfort et al. Acta Obstet Gynecol Scand. 2020 Jul.

Abstract

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.

Keywords: adherence; aspirin; preeclampsia; pregnancy.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Flowchart participant enrollment of Expect Study II
Figure 2
Figure 2
Women’s intentions regarding low‐dose aspirin (LDA) usage after risk‐based counseling and reported LDA usage
Figure 3
Figure 3
Estimated preeclampsia risks and low‐dose aspirin usage rates by women receiving care‐as‐usual or risk‐based care [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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