Prevalence, Patterns, and Factors Associated With Use of Low Dose Aspirin During Pregnancy Among the Pregnant Women at Risk of Preeclampsia at Kenyatta National Hospital: a Descriptive Cross-sectional Study

Abstract

Background: The use of low-dose aspirin (LDA) among pregnant women at risk of pre-eclampsia is a well-established, evidence-based intervention aimed at preventing or delaying the onset of early-onset pre-eclampsia and mitigating the associated adverse maternal and perinatal outcomes. The International Federation of Gynecology and Obstetrics (FIGO) recommends that all pregnant women undergo first-trimester screening to assess their risk for pre-eclampsia. Those identified as at risk should commence LDA at a dosage of 150 mg nightly, starting between 11 and 14 weeks and 6 days, continuing until 36 weeks of gestation. A combined screening approach incorporating maternal factors, mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor (PLGF) is advocated. In settings with limited resources, risk assessment should be conducted using at least maternal factors and mean arterial pressure. The World Health Organization's 2021 guidelines on antiplatelet use for pre-eclampsia prevention recommend a 75 mg dose of LDA for pregnant women at moderate or high risk of the condition. Although evidence suggests that higher doses are more efficacious, the guideline development group expressed concerns about the potential risk of postpartum hemorrhage. There is currently no universal consensus regarding the optimal methods for pre-eclampsia risk screening or the appropriate aspirin dosage. Kenya's National Guidelines on Quality Obstetrics and Perinatal Care, published in February 2022, endorse LDA for pre-eclampsia prevention but lack specific guidelines on dosage, initiation timing, and discontinuation. There is substantial evidence supporting LDA's efficacy in reducing the incidence of pre-eclampsia and its adverse effects. Nevertheless, the uptake of LDA remains low across high-, middle-, and low-income countries. The Confidential Enquiry into Maternal Deaths in Kenya's First Report Summary (2017) identifies hypertensive disorders in pregnancy as the second leading cause of maternal mortality, accounting for 19.74% of all direct maternal deaths. Understanding the prevalence of LDA use is crucial for developing targeted interventions to enhance its uptake among at-risk pregnant women, thereby reducing the adverse maternal and perinatal outcomes associated with pre-eclampsia.