Increasing prescribing of acetylsalicylic acid in pregnancy

Objective To determine the proportion of patients with a singleton pregnancy who are at risk for preeclampsia, based on a Society of Obstetricians and Gynaecologists of Canada guideline that reclassified a body mass index value greater than 30 kg/m2 as a stand-alone indication for daily acetylsalicylic acid (ASA) prophylaxis, and to assess the impact of a single educational session on clinicians’ prescribing of ASA prophylaxis. Design A pre-post study evaluated prescribing of preventive ASA for patients at risk for preeclampsia, as documented in electronic medical records (EMRs) before and after a lunch-and-learn session. Setting Two private family medicine clinics located in a regional centre in Saskatchewan. Participants The EMRs of all patients with a singleton pregnancy who received care at either of the 2 participating clinics between January 1 and March 31, 2023 (pre-intervention period) or between February 1 and April 30, 2024 (post-intervention period) were retrospectively reviewed. Main outcome measures The proportion of patients at risk for preeclampsia, and the proportion of those patients who were prescribed prophylactic ASA. Results Of the 119 patients evaluated, 95 had sufficient information to determine their risk status, of whom 46 (48%) were at increased risk for preeclampsia. ASA use increased statistically significantly among at-risk patients after the educational session; 2 of 29 (7%) patients received ASA before and 6 of 17 (35%) after the intervention (odds ratio=5.8; 95% confidence interval 2.2 to 15.7). More than 85% of patients in both intervention periods presented before 16 weeks’ gestation, the recommended time for ASA initiation. Conclusion Approximately half of the patients with singleton pregnancies in the community were eligible for ASA prophylaxis. Family physicians who provide early prenatal care and see patients during the optimal time for initiating prophylaxis with ASA infrequently provide this preventive treatment. A single educational session increased physicians’ ASA prescription rates, but additional strategies are warranted.