Abstract
Objective Low-dose aspirin is recommended for preeclampsia prevention among women with high-risk
conditions, including chronic hypertension. Black women have higher rates of hypertensive
disorders of pregnancy, and whether this is related to disparities in aspirin prophylaxis
is unknown. We investigated the relationship between race and counseling/prescription
and uptake of aspirin among a cohort of women with chronic hypertension.
Study Design This is a single-institution, retrospective cohort study of women with chronic hypertension
who delivered between 2016 and 2018. Medical record review was performed to assess
counseling/prescription of aspirin prophylaxis and self-reported uptake. Self-reported
uptake was determined by mention in the provider's notes or by inclusion in the medication
reconciliation system. Demographic and obstetric outcome data were compared by self-reported
race (Black vs. all other races) in univariate analysis. Multivariable logistic regression
analysis was performed to evaluate the association between race and aspirin adherence.
Results We included 872 women: 361 (41.4%) Black women and 511 (58.6%) white or other race
women. Overall, 567 (65.0%) women were counseled and/or given a prescription for aspirin,
and 411 (72.4%) of those women reported uptake. Black women were equally likely to
be counseled and/or prescribed aspirin compared with all other races (67.3 vs. 63.4%;
p = 0.7). However, Black women were less likely to report uptake of aspirin (63.8 vs.
79.0%; p < 0.001). After adjustment for total prenatal visits and tobacco use, Black race
was associated with an adjusted odds ratio of 0.53 (95% confidence interval: 0.36–0.78)
for uptake of aspirin.
Conclusion In our cohort, recommendation for aspirin prophylaxis was suboptimal in all groups,
reaching only 65% of eligible women. Black women were equally likely as women of other
races to receive counseling about aspirin, but rates of uptake were lower. Our findings
suggest that counseling and prescription of aspirin alone in high-risk Black women
are not sufficient for utilization of this intervention.
Key Points
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Rates of counseling about aspirin prophylaxis for preeclampsia did not vary by race.
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Black women had lower rates of uptake of aspirin compared with women of other races.
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Counseling about aspirin was inadequate in general, reaching only 65% of eligible
women.
Keywords
preeclampsia - aspirin - racial disparities - medication uptake
