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Hypertensive disorders of pregnancy pre- and post-aspirin guideline publication in individuals with pre-gestational diabetes mellitus

  • Ann M. BRUNO
    Correspondence
    Corresponding Author: Ann Bruno, Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, University of Utah Health
    Affiliations
    Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT, USA

    Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Intermountain Healthcare, Murray, UT, USA
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  • Ms. Amanda A. ALLSHOUSE
    Affiliations
    Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT, USA
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  • Torri D. METZ
    Affiliations
    Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT, USA

    Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Intermountain Healthcare, Murray, UT, USA
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  • Lauren H. THEILEN
    Affiliations
    Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT, USA

    Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Intermountain Healthcare, Murray, UT, USA
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Published:January 25, 2023DOI:https://doi.org/10.1016/j.ajogmf.2023.100877

      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

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