A new study out of Parkland Health and UT Southwestern could change how healthcare providers prevent one of the leading causes of infant and maternal mortality and morbidity.<\/p>\n
Preeclampsia<\/a>, a condition that involves \u201cdangerously\u201d high blood pressure during pregnancy, can lead to seizures, stroke or even death for both the parent and the child if left untreated. Parkland and UT Southwestern researchers found that prescribing every pregnant patient a daily low-dose aspirin tablet at their first prenatal visit led to a \u201csignificant drop\u201d in severe preeclampsia.<\/p>\n \u201cOne thing that this might do is move the needle and make physicians and other providers more comfortable giving aspirin to a larger population who could benefit from it,\u201d said Dr. Elaine Duryea, chief of obstetrics at Parkland and associate professor of Obstetrics and Gynecology at UT Southwestern.<\/p>\n Decrease in severe preeclampsia<\/p>\n Over the length of the study, the rate of severe preeclampsia went from about 7% to about 5% of pregnant Parkland patients.<\/p>\n \u201cIt does not seem perhaps like a huge change, but clinically it is a very large difference,\u201d Duryea said. \u201cAs an institution that delivers over 13,000 babies a year, if you start doing the math, you realize that\u2019s a very large number of patients that won\u2019t suffer from these severe complications and can have a safer, more routine delivery.\u201d<\/p>\n The study, published in the American Journal of Obstetrics and Gynecology in August<\/a>, looked at more than 36,000 deliveries at Parkland Memorial Hospital from 2020 to 2025 \u2013 before and after the hospital started universally prescribing aspirin. The medication was prescribed to patients who started receiving prenatal care before they were 16 weeks into their pregnancy, since previous research doesn\u2019t show a benefit for people who start taking aspirin later.<\/p>\n Even though aspirin didn\u2019t outright prevent every patient from developing preeclampsia, Duryea said it was typically much less severe and developed later in the pregnancy. The rate of severe complications dropped by more than 25%.<\/p>\n The effect wasn\u2019t exclusive to just one demographic group. Duryea said it worked whether patients had chronic hypertension or not, and across every race and ethnicity studied. \u201cWith 18,000 women taking aspirin, there was no harm to taking it that we could detect,\u201d she said.<\/p>\n Going from no recommendation to a universal one<\/p>\n Parkland didn\u2019t have a recommendation for patients to take aspirin as prevention for conditions like preeclampsia until 2022.<\/p>\n Before then, the American College of Obstetricians and Gynecologists<\/a> and the Society for Maternal-Fetal Medicine recommended a screening approach that identifies patients who are considered high risk for the condition based like prior medical conditions, family history and socioeconomic status. Aspirin was then prescribed based on the results.<\/p>\n \u201cThat risk screening can be quite cumbersome,\u201d Duryea said. \u201cA lot of patients may not know extensive family history. It does have a lot of challenges and shortcomings. And at our institution, it was really difficult for us to implement.\u201d<\/p>\n Duryea said a lot of studies have showed most healthcare facilities aren\u2019t great at implementing the screening in a widespread fashion \u2013 meaning some patients who would have been considered \u201cmoderate to high risk\u201d weren\u2019t identified.<\/p>\n Then, at the end of 2021, the two professional associations that created the screening provided additional guidance that said universal aspirin may be a reasonable approach for institutions where most of the patients may be at high or moderate risk for preeclampsia.<\/p>\n Duryea estimates over 90% of Parkland\u2019s pregnant patients qualified for aspirin under new criteria that recommended it for more moderate risk factors \u2013 making universal aspirin the best approach.<\/p>\n \u201cWhen that guideline came out, we all sat in a room and we said ‘that, we can do really well,\u2019\u201d she said. \u201cWe are really good at implementing a system-wide initiative in a way that is really easy for patients and providers.\u201d<\/p>\n Because Parkland Memorial Hospital has such a high volume of deliveries, Duryea said it was possible to get a clearer picture of how much this approach works on a population level. She said there still needs to be more analysis done in other communities and nationwide to strengthen the research.<\/p>\n Duryea said she and her team are interested in expanding the effort across North Texas to see if they can demonstrate the same benefit in a larger population.<\/p>\n \u201cAs far as treatment, I hope that other similar institutions can look at this and see if it\u2019s a good fit for them,\u201d she said, \u201cespecially places that are struggling with consistently implementing risk-based screening and treatment.\u201d<\/p>\n Abigail Ruhman is KERA\u2019s health reporter. Got a tip? Email Abigail at\u00a0aruhman@kera.org<\/a>.<\/p>\n
One of the most important things the study found, according to Duryea, was that there were no severe adverse effects as a result of taking the medication daily.<\/p>\n