Increasing aspirin adherence in pregnant women at risk for preeclampsia
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Hypertensive disease in pregnancy, including preeclampsia, is the leading cause of perinatal morbidity and mortality in the United States. Preeclampsia, characterized by new onset hypertension and proteinuria, can cause seizures, cerebral hemorrhage, pulmonary edema, placental abruption, premature birth, and death. The only definitive treatment for preeclampsia is delivery of the fetus. However, studies have shown that daily low dose aspirin (LDA) can reduce the risk of preeclampsia without increasing negative outcomes, such as bleeding. Despite this evidence, LDA has yet to be implemented routinely in prenatal care in the United States. The aim of this study is to improve LDA implementation by increasing adherence to the medication once it is prescribed by the provider. While some studies have shown that providing patient education or increasing family support increases medication adherence, very few studies have assessed medication adherence in a pregnant population. Even fewer studies have assessed adherence to LDA to prevent preeclampsia. We are proposing a quality improvement project within the OBGYN clinic at Boston Medical Center to assess the barriers to medication adherence, to identify effective patient-directed implementation strategies to increase adherence, and to reach an adherence rate of 90% in twelve months. Identifying and implementing effective strategies to increase medication adherence to LDA has the potential to reduce the rate of preeclampsia and the associated negative perinatal outcomes.