Missed opportunities for administration of low-dose aspirin to pregnant women at high risk of preeclampsia at Kawempe National Referral Hospital

Abstract

Background: Evidence suggests low-dose aspirin (LDA) prophylaxis given between 11-16 weeks of gestation and stopped at 36 weeks may prevent or delay early onset preeclampsia in high-risk individuals and may reduce maternal morbidity and mortality in patients who develop the disease. Aspirin administration is associated with a risk reduction of up to 25% in preeclampsia development. This study aimed to determine the missed opportunities for low-dose aspirin administration to high-risk pregnant women with preeclampsia at Kawempe National Referral Hospital. Methods: This was a cross-sectional study among pregnant women with preeclampsia who demonstrated risk factors for preeclampsia before diagnosis of preeclampsia. These were assessed if they were administrated with LDA and any factors associated with missed opportunities for LDA. The data was collected using an interviewer administered questionnaire and analysed using SPSS version 19. Modified Poisson regression analysis including bivariate and multivariate analysis was used to measure the associated factors. Results: 288 mothers were recruited with an average age of 30.74±6.14 years and majority (91.3%, 263/288) were married. The prevalence of missed opportunities for the administration of LDA was 91.0%. For those who had LDA prescribed, majority (80.8%, 21/26) were administered with 75 mg aspirin and 19.2% (5/26) were administered with 150mg. Aspirin was predominantly initiated between 11–16 weeks of gestation in 61.5%, 16/26 and majority were given a once-daily regimen (84.6%, 22/26). The missed opportunities for LDA administration were more likely in women without a history of preeclampsia [aPR= 1.98, 95% CI: 1.34–2.58, P = 0.02] or chronic hypertension [aPR = 3.78, 95% CI: 1.59–6.57, P = 0.013] as compared those with such a history. Additionally, women who reported the unavailability of LDA at their antenatal care (ANC) site were more likely to miss LDA administration compared to those who reported LDA as consistently available at their ANC site [aPR = 4.32, 95% CI: 2.54–5.94, P = 0.018]. Conclusion: The findings of this study highlight significant gaps in the administration of low-dose aspirin (LDA) for preeclampsia prevention, with missed opportunities being more likely among women without a history of preeclampsia or chronic hypertension and those who reported LDA unavailability at antenatal care sites. There is need for enhanced adherence to preeclampsia prevention protocols among Uganda healthcare provers. Key words: Low-Dose Aspirin, Preeclampsia, Missed Opportunities.