Feasibility of Universal Screening for Preeclampsia Risk and Aspirin Recommendation in the Ultrasound Unit

Verónica Maria Pimentel; Alexander D Almeida Larrea; Sophie J Renaud; Sophie Sloan; Reinaldo Figueroa; Dorothy Wakefield; Rebecca Crowell

doi:10.1055/s-0043-1777445

Feasibility of Universal Screening for Preeclampsia Risk and Aspirin Recommendation in the Ultrasound Unit

Am J Perinatol. 2023 Dec 15. doi: 10.1055/s-0043-1777445. Online ahead of print.

Authors

Verónica Maria Pimentel^{1

2

3}, Alexander D Almeida Larrea¹, Sophie J Renaud², Sophie Sloan¹, Reinaldo Figueroa^{1

2}, Dorothy Wakefield⁴, Rebecca Crowell⁴

Affiliations

¹ Department of Obstetrics and Gynecology, Saint Francis Hospital and Medical Center, Hartford Connecticut.
² Department of Obstetrics and Gynecology, Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut.
³ Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Connecticut.
⁴ Department of Research, Saint Francis Hospital and Medical Center, Hartford, Connecticut.

PMID: 38101442
DOI: 10.1055/s-0043-1777445

Abstract

Objective: To evaluate the feasibility and impact of using the first-trimester ultrasound visit to identify and counsel women at increased risk of preeclampsia about the benefits of low-dose aspirin (LDA) for preventing preeclampsia. We also assessed patient-reported utilization of LDA, perceived risk for preeclampsia, and clinical outcomes.

Study design: Women presenting for routine first-trimester nuchal-translucency (NT) ultrasounds were screened for clinical preeclampsia risks using a self-administered risk assessment. Women at moderate or high risk for preeclampsia were counseled to take LDA, if not already taking it. LDA utilization and perceived risk for preeclampsia were assessed during the second-trimester ultrasound. Factors associated with LDA utilization were analyzed. Pregnancy outcomes were compared between those who used LDA and those who did not.

Results: Slightly more than 20% of patients (765/3,669) screened at increased risk for developing preeclampsia. Of those, 67.8% (519/765) had not received LDA recommendations from their referring obstetrician and 97 had not been taking LDA despite being advised to do so. Combined, 94.6% (583/616) of these patients eligible to start LDA prophylaxis received the indicated counseling during the ultrasound visit. A total of 61.4% (358/583) of women completed the follow-up form and of those 77.9% (279/358) reported taking LDA. Screening at increased risk for preeclampsia and perception of increased risk were positively associated with LDA utilization, whereas concerns for LDA safety were negatively associated with use. African American/Black patients and Medicaid recipients were less likely to use LDA. Pregnancy outcomes were similar between those who used LDA and those who did not.

Conclusion: Assessing preeclampsia risk and counseling patients about LDA at the time of the NT ultrasound are feasible in the ultrasound unit and led to good LDA utilization among women at increased risk for preeclampsia. This intervention may standardize patient care and help close the disparity in maternal health.

Key points: · A simple intervention captured 2/3 of eligible patients.. · Aspirin utilization rate was good after the intervention.. · Screening high risk for preeclampsia and self-perception of risk correlated with aspirin use..