Abstract
Background
The U.S. Preventive Services Taskforce (USPSTF) published guidelines in 2014 recommending
low-dose aspirin be initiated between 12- and 28-weeks’ gestation among high risk
patients for preeclampsia prophylaxis. Low-dose aspirin is also recommended by some
clinicians for prevention of preterm birth.
Objective
To evaluate if there is an association between publication of the USPSTF aspirin guideline
and rates of hypertensive disorders of pregnancy and preterm birth in individuals
with pre-gestational diabetes mellitus.
Study Design
This was a repeated cross-sectional analysis of individuals with pre-gestational diabetes
mellitus and at least one singleton delivery >20 weeks’ gestation with records available
in the National Vital Statistics System between 2010 and 2018. The primary outcome
was hypertensive disorders of pregnancy, and the secondary outcome was preterm birth.
Demographics and clinical characteristics among individuals in the pre-USPSTF guideline
cohort (2010-2013) were compared to individuals in the post-USPSTF guideline cohort
(2015-2018). Multivariable regression estimated odds ratios and 95% confidence intervals
for the association between guideline publication and the selected endpoints. Effect
modification was assessed for access to prenatal care using the Kotelchuck index (KI
<80% vs ≥ 80%). A sensitivity analysis limited to nulliparas was also performed.
Results
224,065 individuals were included. Individuals in the post-USPSTF guideline cohort
were more likely to be older, obese, and have a history of preterm birth. In unadjusted
and adjusted modeling, delivery in the post-USPSTF guideline cohort was associated
with hypertensive disorders of pregnancy (aOR 1.25, 95% CI 1.22-1.28) and preterm
birth (aOR 1.10, 95% CI 1.08-1.12). Adjusted odds ratios for hypertensive disorders
of pregnancy and preterm birth were more pronounced among those with less than adequate
access to care. Findings were similar in sensitivity analysis of only nulliparas.
Conclusion
Delivery post-USPSTF aspirin guideline publication was associated with higher rates
of hypertensive disorders of pregnancy and preterm birth in a population of individuals
with diabetes mellitus. It is unknown whether patient or practitioner factors, or
other changes in obstetric care, contributed to these findings.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Obstetrics & Gynecology MFMAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
Article info
Publication history
Accepted:
January 18,
2023
Received:
January 12,
2023
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
