Ganem Nadir, Frank Wolf Maya, Kayal Raneen Sawaid, Aiob Ala, Gumin Dina, Lowenstein Lior, Sgayer Inshirah
Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.
Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
Int J Womens Health. 2025 Sep 5;17:2909-2917. doi: 10.2147/IJWH.S536497. eCollection 2025.
To evaluate real-world prescribing patterns of low-dose aspirin for preeclampsia prevention among pregnant women who met the Israeli or American College of Obstetricians and Gynecologists (ACOG) guideline criteria for preeclampsia prophylaxis, and to identify disparities and missed opportunities in implementing risk-based prophylaxis in a diverse obstetric population.
This retrospective study analyzed women who delivered live births at a tertiary medical center in northern Israel between March 2020 and April 2024. Eligibility for low-dose aspirin prophylaxis was assessed using Israeli guidelines, focusing on major risk factors, and the broader ACOG criteria, which include moderate-risk factors. This dual approach reflects debates in Israel about incorporating moderate-risk factors into routine clinical practice.
Of 18,838 women included, 1,160 (6.2%) met the criteria for low-dose aspirin prophylaxis under Israeli guidelines, and 511 (44.1%) of these received prescriptions. The prescription rate was highest among women with a history of preeclampsia (79.0%) and pregestational diabetes (66.3%) but notably lower among those with chronic hypertension (30.3%) and autoimmune diseases (41.3%). Under ACOG criteria, 2,559 women (13.6%) were eligible for low-dose aspirin, but only 27.9% (715/2,559) received prophylaxis. The prescription rate was significantly higher among women with high-risk factors than among those with only moderate-risk factors (OR=0.16, p<0.001). Arab women were more likely to receive low-dose aspirin than were Jewish women (31.2% vs 24.5%, p<0.001), consistent with higher prevalences of risk factors. Multivariate analysis showed that a history of preeclampsia (OR=7.15, p<0.001) and pregestational diabetes (OR=3.80, p<0.001) were strongly associated with low-dose aspirin prescription.
Our findings reveal suboptimal prescription of low-dose aspirin according to guideline criteria, especially among women with moderate-risk factors. Even among women with high-risk factors, disparities in prescribing practices persisted. These gaps highlight the need for better provider education, consistent risk assessment, and structured implementation strategies to improve guideline adherence.
评估符合以色列或美国妇产科医师学会（ACOG）子痫前期预防指南标准的孕妇中低剂量阿司匹林预防子痫前期的实际处方模式，并确定在不同产科人群中实施基于风险的预防措施时存在的差异和错失的机会。
这项回顾性研究分析了2020年3月至2024年4月期间在以色列北部一家三级医疗中心分娩活产的妇女。使用以色列指南评估低剂量阿司匹林预防的 eligibility，重点关注主要风险因素，以及更广泛的ACOG标准，其中包括中度风险因素。这种双重方法反映了以色列关于将中度风险因素纳入常规临床实践的争论。
在纳入的18838名妇女中，1160名（6.2%）符合以色列指南下低剂量阿司匹林预防的标准，其中511名（44.1%）接受了处方。子痫前期病史（79.0%）和孕前糖尿病（66.3%）的妇女处方率最高，但慢性高血压（30.3%）和自身免疫性疾病（41.3%）的妇女处方率明显较低。根据ACOG标准，2559名妇女（13.6%）有资格使用低剂量阿司匹林，但只有27.9%（715/2559）接受了预防。有高危因素的妇女的处方率明显高于只有中度风险因素的妇女（OR = 0.16，p < 0.001）。阿拉伯妇女比犹太妇女更有可能接受低剂量阿司匹林（31.2%对24.5%，p < 0.001），这与风险因素的较高患病率一致。多变量分析显示，子痫前期病史（OR = 搜索结果7.15，p < 0.001）和孕前糖尿病（OR = 3.80，p < 0.001）与低剂量阿司匹林处方密切相关。
我们的研究结果显示，根据指南标准，低剂量阿司匹林的处方不理想，尤其是在有中度风险因素的妇女中。即使在有高危因素的妇女中，处方实践中的差异仍然存在。这些差距凸显了加强提供者教育、进行一致的风险评估以及制定结构化实施策略以提高指南依从性的必要性。
