Many high-risk pregnant patients still miss out on guideline-recommended care
New research highlights a major gap in preventive care for pregnant patients at risk of preeclampsia: approximately 76% of patients are not being receiving guideline-recommended care.
Emily Lau, MD, MPH, director of the Women’s Heart Health Program at Brigham and Women's Hospital, presented the data at ACC.26. She spoke to Cardiovascular Business about her findings for an exclusive interview.
“We have a low-cost, effective, easily accessible therapy to prevent preeclampsia, and that’s low-dose aspirin,” Lau said. “And we also know that preeclampsia is a major contributor to maternal morbidity and mortality.”
Despite clear guidelines, many patients still miss out on care
The study analyzed electronic health record data from more than 60,000 pregnancies across the Mass General Brigham health system between 2013 and 2023. Researchers focused on patients facing a high risk for preeclampsia—those who clinical guidelines recommend be treated with aspirin prophylaxis.
Recommendations from the U.S. Preventive Services Task Force in 2015 and the American College of Obstetricians and Gynecologists (ACOG) in 2018 were expected to improve low-dose aspirin uptake. While use did increase over time, adherence remains low.
Only 4% of high-risk patients received aspirin in 2013. That figure rose modestly to about 12% after ACOG’s endorsement, and reached just 24% by 2023. Lay said this was less than a quarter of eligible patients.
Missed opportunities in preeclampsia high-risk groups
The study also found that some high-risk patients, such as those with autoimmune or renal disease, were not consistently receiving aspirin therapy. She suggested that part of the problem may be inconsistent identification of high-risk patients in busy clinical settings, especially when they do not appear acutely ill.
Long-term cardiovascular implications or preeclampsia
Preeclampsia affects up to 8% of pregnancies and is increasingly recognized not only as a short-term obstetric complication, but also as an early warning sign of future cardiovascular disease.
“More and more data have shown us that preeclampsia is also a harbinger for later-life cardiovascular disease risk," Lau said.
This growing body of evidence has led to the inclusion of adverse pregnancy outcomes as risk-enhancing factors in cardiovascular disease guidelines, though Lau emphasized that more work is needed.
The need for better guideline-directed, interdisciplinary care
The research team's findings underscore the broader challenge in medicine of translating evidence-based guidelines into routine clinical practice. Lau called for more systematic approaches, including better risk identification and clinical workflows, to ensure eligible patients receive preventive care.
She also pointed to the expanding role of cardio-obstetrics programs, which bring together cardiologists, obstetricians and other specialists to manage complex pregnancies and improve the continuity of care.
Lau said the period after delivery when patients move from obstetric to primary care is a point when they are especially vulnerable. Awareness needs to grows around the long-term cardiovascular risks associated with pregnancy complications, she added. Increasing adherence to simple, low-cost interventions like aspirin could have lasting benefits for women’s health.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]