Evaluating Best-Practice-Advisors at Mitigating Ethnic disparities in Low-Dose-Aspirin Recommendation for Pre-Eclampsia

Introduction

Preeclampsia significantly contributes to adverse maternal and fetal outcomes. The American College of Obstetricians and Gynecologists (ACOG) recommends low-dose aspirin (LDA) for high-risk women to prevent preeclampsia. Despite this, significant racial/ethnic disparities exist in LDA utilization. Electronic Best Practice Alerts (eBPAs) may improve compliance with LDA recommendations. This study evaluates whether an eBPA implementation mitigated racial/ethnic disparities in LDA prescribing and preeclampsia incidence in an urban academic medical center.

Methods

A retrospective cohort of 15,216 pregnant women, categorized into four groups (White, Black, Other, and Missing), was analyzed before and after eBPA implementation. Preeclampsia incidence and LDA prescription rates were stratified by gestational age, race, and preeclampsia risk categories. Rao-Scott Chi-Square and logistic regression analyses were conducted to assess changes in LDA prescribing and preeclampsia rates.

Results

Post-eBPA, LDA prescription rates increased significantly across all risk categories, particularly among Black women (p < .0001). White women showed a significant reduction in preeclampsia incidence post-eBPA (p < .0001), while Black women had the highest preeclampsia risk and showed no significant reduction in risk post-eBPA (p = 0.1964). Racial disparities in LDA uptake and preeclampsia risk remained, with Black women experiencing persistently higher risk compared to other racial groups. The eBPA had a modest overall effect on reducing preeclampsia incidence (p = 0.0479).

Conclusion

While eBPA implementation increased LDA prescribing, it did not substantially mitigate racial/ethnic disparities in preeclampsia risk, particularly among Black women. Further strategies are needed to address these persistent disparities and ensure equitable health outcomes.