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An app could promote informed and healthy pregnancies

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  • Health and Wellness
  • Innovation and Research
  • School of Medicine

Low-dose aspirin during pregnancy can help prevent preeclampsia, a serious yet common hypertension disorder 鈥 but it is underused among high-risk pregnant patients. A new study published today in听听suggests this could potentially be due to a communication gap with providers.

The study evaluated听听risk and a patient鈥檚 adherence to aspirin recommendations by comparing medical records to results of patient surveys conducted with the听听smartphone app, which was developed by听91porn视频, UPMC听补苍诲听Carnegie Mellon University听researchers. Among patients who reported at least one high-risk factor for preeclampsia and had a low-dose aspirin recommendation documented in their medical records, about 37% were unaware they鈥檇 been advised to take the medication. The app could help bridge this gap and improve adherence to clinical guidance, say the researchers.

鈥淲e see this app as a way to augment the patient-provider dyad,鈥 said senior author听, professor and executive vice chair of obstetrical services at Pitt and director of clinical innovation for the Women鈥檚 Health Service Line at听UPMC Magee-Womens Hospital. 鈥淭his digital tool has potential to offer additional support and information for patients to navigate on their own and also facilitate further conversation with their providers about aspirin eligibility. This could empower patients to make more informed decisions for a healthy pregnancy.鈥

Preeclampsia can lead to serious and even fatal complications for both mother and baby. The condition can damage the mother鈥檚 organs and impact the placenta, restricting fetal growth and increasing the risk of preterm delivery and stillbirth. Daily low-dose aspirin can prevent preeclampsia and reduce these risks, and the听U.S. Preventive Services Task Force听recommends this medication for pregnant people with at least one high-risk factor or at least two moderate risk factors. However, identifying people with these risk factors and communicating aspirin recommendations is a challenge.

鈥淲e built the MyHealthyPregnancy platform 鈥 which is a patient-facing smartphone app and a provider-facing portal 鈥 to help with identification of preeclampsia risk factors and other risks related to preterm birth earlier than possible through routine prenatal care,鈥 said lead author听, assistant professor of medicine and clinical and translational science in Pitt鈥檚听School of Medicine.听

Simhan, Krishnamurti and their team analyzed data from pregnant participants who responded to optional questions about preeclampsia risk on the app. Of that group, 124 participants had one or more high-risk criteria and also answered voluntary questions about aspirin. The medical records of 90 patients contained documented evidence that providers had advised them to take a low-dose aspirin, but only 57, or 63%, were aware of the recommendation. The other 37% didn鈥檛 recall this advice.

鈥淭he finding that many patients didn鈥檛 recall an aspirin recommendation highlights that there is huge opportunity to improve information-sharing,鈥 said Krishnamurti. 鈥淲e had incredibly high engagement with participant responses to voluntary questions through the MyHealthyPregnancy app, so there is real opportunity to leverage this engagement to bridge communication gaps between providers and patients.鈥

Thirty-four of 124 patients with at least one high-risk criterion said that they had not been recommended aspirin, in line with their medical records. In addition, of 441 participants with two or more moderate-risk criteria who answered questions related to aspirin, only 3% to 6% reported that they had been advised to take low-dose aspirin. These findings suggest that providers may miss certain risk factors and that many patients who could benefit from low-dose aspirin are not receiving these recommendations.听

Of all the participants who reported receiving an aspirin prescription, only about 49% said that they took the medication in adherence with guidelines, highlighting a challenge in health care known as 鈥渘on-adherence,鈥 where patients do not follow provider recommendations.听

The researchers say that the MyHealthyPregnancy digital platform could help flag patients with preeclampsia risk factors to providers and increase adherence by improving communication about potential benefits of aspirin and reminding patients to take medication.听

鈥淭he app could provide a more nuanced understanding of aspirin use for preeclampsia than there may be time for during a provider appointment,鈥 said Simhan.

Because the vast majority of U.S. adults own a smartphone, the researchers say that digital tools like the app could contribute to addressing听racial disparities in preeclampsia rates听by identifying people at risk early in their pregnancy.

The app currently is offered only to patients in the UPMC network by prescription, but the researchers will next test it in other health care systems and hope to make it available more widely in the future.

Other authors on the study were Alexander L. Davis, Carnegie Mellon University; Samantha Rodriguez and Laila Hayani, Naima Health LLC; and Miriam Bernard of Pitt.

The research was supported by the听Centers for Disease Control and Prevention, the听Richard King Mellon Foundation听补苍诲听S&R Foundation鈥檚 Kuno Award for Applied Science for the Social Good.

鈥 Asher G. Jones