Yet a new study paints a disturbing picture of the inadequacy of current guidelines for assessing risk for preeclampsia. This serious condition affects about 4% of all pregnancies in the United States. These findings illuminate a major disconnect between present-day practices and protocols. Yet they continue to inadequately serve the needs of high-risk populations, particularly non-Hispanic Black women, who are at an increased risk of this worrisome pregnancy complication.
Preeclampsia plays a major role in the US’s persistent maternal mortality crisis. It leads to dangerous maternal and infant health outcomes. The U.S. Preventive Services Task Force (USPSTF) currently recommends low-dose aspirin for patients identified as having at least one high-risk factor for preeclampsia. Unfortunately, studies show that most patients eligible for this important preventative step aren’t getting it.
Two of the study’s authors, Thomas McElrath, an obstetrician-gynecologist at Brigham and Women’s Hospital, and Cynthia Gyamfi-Bannerman, a maternal-fetal medicine specialist at UC San Diego Health, have raised some red flags. They are concerned that existing screening practices can lead to missed opportunities. Known high-risk factors for preeclampsia include history of preeclampsia and pregestational diabetes. Moderate risk factors include obesity and advanced maternal age.
Even with these guidelines in place, only 23.8% of patients with at least one moderate risk factor were on aspirin prophylaxis. This rate jumps to 50.4% in patients with two or more moderate risk factors. Alarmingly, the study found less than 1 in 10 moderate-risk patients developed preeclampsia, while more than 1 in 4 high-risk patients did.
As people who study health inequities, the researchers noticed that certain populations were underrepresented in the study. This particularly included people with multigestational pregnancies and conceived via in vitro fertilization, as they have a significantly increased risk of preeclampsia. This exclusion leads to concerns about how generalizable the results are to other patient populations.
When talking about what the study means, McAdow focused on the need for better screening.
“There is certainly an opportunity for us to do better with a more stringent screening test.” – Molly McAdow
McElrath agreed with this sentiment, explaining that a more tailored, flexible approach to risk assessment is what many practitioners want.
“A lot of times, people wanted it to be a little bit more personalized,” – Thomas McElrath
To continue providing quality, effective care, these findings underscore a critical need for healthcare providers to… They need to improve their screening mechanisms to better identify the women most at risk. Michael Silverstein, MD, is a nationally recognized expert in maternal health research. He is insistent that there have been enough recent high-quality studies to demonstrate exactly how aspirin should be used to prevent preeclampsia in high-risk women.
“The Task Force’s rigorous review of all the latest high-quality research clearly shows that taking aspirin helps women at high risk prevent preeclampsia, improving their health and the health of their babies,” – Michael Silverstein
Addressing the larger issue Silverstein called attention to darker trend in maternal health across America.
“Fundamentally, one of the best ways to help address the maternal mortality crisis is to ensure that everyone who is pregnant is able to access the preventive services that have been proven to help save their lives.” – Michael Silverstein
Unfortunately, this study isn’t the only important contribution to the ongoing debate about maternal health. It shines a light on the pressing need to strengthen clinical recommendations for risk assessment of preeclampsia. While our healthcare providers do everything they can to combat shocking rates of maternal mortality, it’s high time for them to embrace broader and more tailored approaches to patient care.
