Duke University School of Medicine, Durham, North Carolina.
Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, Duke University School of Medicine, Durham, North Carolina.
Am J Perinatol. 2024 May;41(S 01):e2004-e2009. doi: 10.1055/a-2096-3466. Epub 2023 May 19.
The primary aim of this study was to examine the United States Preventative Services Task Force (USPSTF) guidelines concordant low-dose aspirin (LDA) counseling and factors associated with counseling in nulliparous birthing individuals.
We conducted a retrospective cohort study of nulliparous birthing individuals who delivered between January 1, 2019 and June 30, 2020 and received prenatal care at the Duke High Risk Obstetrical Clinics (HROB). All nulliparous patients over 18 years old who established or transferred care to HROB by 16 weeks, 6 days were included in the analysis. We excluded patients with more than two previous first-trimester pregnancy losses, multiple gestation, a known contraindication to LDA, initiation of LDA prior to their prenatal care, or documented medical history of coagulation disorder. Bivariate associations between demographic/medical characteristics and our primary outcome, receipt of counseling (yes/no), were assessed using two-sample -tests for continuous variables and chi-square or Fisher's exact test for categorical variables. Factors significantly associated with the primary outcome ( < 0.05) were entered into the multivariable logistic regression model.
Among 391 birthing individuals included in the final analysis cohort, 51.7% of eligible patients received guideline consistent LDA counseling. Factors associated with increased odds of LDA counseling were advanced maternal age (adjusted odds ratio [aOR]: 1.05, 95% confidence interval [CI]: 1.01-1.09), Black race compared with White race (aOR:1.75, 95% CI: 1.03-2.98), chronic hypertension (aOR: 4.17, 95% CI: 1.82-9.55), and obesity (aOR: 5.02, 95% CI: 3.12-8.08).
Approximately half of all nulliparous birthing individuals had appropriately documented LDA counseling. The USPSTF guidelines on LDA for preeclampsia risk reduction are complex, which may lead to ineffective provider adherence. Efforts to simplify guidelines and improve LDA counseling are vital to ensuring this low-cost, evidence-based preeclampsia prevention is used in a consistent and equitable manner.
· A total of 51.7% of eligible patients received guideline consistent LDA counseling.. · Advanced maternal age , body mass index > 30, Black race, and chronic hypertension associated with increased odds of counseling.. · Among patients most likely to be counseled, high numbers did not receive LDA counseling..
本研究的主要目的是检查美国预防服务工作组（USPSTF）关于低剂量阿司匹林（LDA）咨询的指南以及与初产妇 LDA 咨询相关的因素。
我们对 2019 年 1 月 1 日至 2020 年 6 月 30 日期间在杜克高危产科诊所（HROB）分娩且接受产前护理的初产妇进行了回顾性队列研究。所有年龄在 18 岁以上、在 16 周 6 天前建立或转至 HROB 接受护理的初产妇均纳入分析。我们排除了既往有两次以上早期妊娠丢失、多胎妊娠、LDA 明确禁忌证、在产前护理前开始 LDA 治疗或有记录的凝血障碍病史的患者。使用两样本 t 检验评估连续变量和卡方检验或 Fisher 精确检验评估分类变量之间的人口统计学/医学特征与主要结局（接受/未接受咨询）之间的双变量关联。对与主要结局显著相关的因素（<0.05）纳入多变量逻辑回归模型。
在最终分析队列中，391 名分娩个体中，51.7%符合条件的患者接受了符合指南的 LDA 咨询。与 LDA 咨询可能性增加相关的因素包括高龄（调整后的优势比[aOR]：1.05，95%置信区间[CI]：1.01-1.09）、黑种人种族与白种人种族（aOR：1.75，95%CI：1.03-2.98）、慢性高血压（aOR：4.17，95%CI：1.82-9.55）和肥胖（aOR：5.02，95%CI：3.12-8.08）。
大约一半的初产妇有记录表明接受了适当的 LDA 咨询。USPSTF 关于 LDA 用于子痫前期风险降低的指南很复杂，这可能导致提供者的依从性不佳。简化指南和改善 LDA 咨询的努力对于确保以一致和公平的方式使用这种低成本、基于证据的子痫前期预防措施至关重要。
·符合条件的患者中，51.7%接受了符合指南的 LDA 咨询。·年龄较大、身体质量指数（BMI）>30、黑种人种族和慢性高血压与咨询可能性增加相关。·在最有可能接受咨询的患者中，很多人并未接受 LDA 咨询。
