Provider Adherence to Aspirin Prophylaxis Prescription Guidelines for Preeclampsia Prevention - A Quality Improvement Project

Document Type

Conference Proceeding

Publication Date


Publication Title

Am J Obstet Gynecol


Objective: Preeclampsia affects 2-8% of pregnancies leading to significant maternal and neonatal morbidity and mortality. The Society for Maternal-Fetal Medicine supports the use of low dose aspirin for the prevention of preeclampsia in women at risk. The aim of this study was to evaluate provider adherence to aspirin prophylaxis prescription guidelines for women at risk.

Study Design: A retrospective chart review was performed at Henry Ford Health System (HFHS) between October 2015 and December 2020. In October 2015, aspirin 81 mg was recommended for women who met high risk criteria for preeclampsia at HFHS; in February 2019, aspirin 162 mg was recommended for women who met moderate or high risk criteria for preeclampsia. Providers prescribing aspirin included attending physicians, physician residents, and certified midwives.

Results: A total of 46,016 pregnancies occurred between Oct 2015 and Dec 2020. 15,167 (33.0%) met high and moderate risk criteria and had no contraindication to aspirin administration. From the population at risk, 1,255 (8.3%) had a history of preeclampsia, 2,534 (16.7%) had a history of chronic hypertension, 1,418 (9.3%) had a history of diabetes, 7,470 (49.3%) were nulliparous, 4,038 (26.6%) were 35 years of age or older, 6,395 (42.2%) had a body mass index greater than 30 kg/m2, and 8,174 (53.9%) were African Americans. Only 630 out of 3,584 (17.6%) of women meeting the high risk criteria for preeclampsia between Oct 2015 and Jan 2019 received aspirin. Only 891 out of 5,874 (15.2%) of women meeting the high or moderate risk criteria for preeclampsia between Feb 2019 and Dec 2020 received aspirin.

Conclusion: Adherence to aspirin prophylaxis guidelines for women at moderate or high risk for preeclampsia was low. Most urban healthcare systems serve diverse, high risk populations with multiple comorbidities rendering many women at moderate or high risk for preeclampsia. Educational efforts to improve provider knowledge regarding this important preventative measure are indicated.





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