Year: 2025
Type: article
Abstract: Currently birth outcomes in the United States lag other industrialized countries and are driven predominantly by adverse pregnancy outcomes including preeclampsia, spontaneous preterm birth, stillbirth and fetal growth restriction.In aggregate these conditions are termed adverse pregnancy outcomes (APOs) and are complex in their origin, but largely reflect placentally mediated conditions that begin in early pregnancy.Low-dose aspirin (LDA) has been shown to lower the risk of APOs, but questions about the optimal dose, patient population to receive it, and barriers to prescribing and adherence have limited the impact of LDA on a population level.Multiple investigations unfortunately have shown that uptake is low and often biased in its provision.To address these inequities in care, the Delaware Perinatal Quality Collaborative (DPQC) organized efforts around standardizing screening all patients, providing hospital level feedback and enhanced patient education.With this effort, the rate of appropriate LDA prescription increased from 10% to 65%.Further studies and thoughtful conversations around additional barriers to care must be addressed jointly by researchers, providers, public health officials, patients and the community at large if the full promise shown in randomized controlled trials is to be realized. Current Status of Obstetrical OutcomesLittle change has occurred in obstetrical outcomes in the last several decades, with most gains in outcomes being attributable to antenatal corticosteroids, improved neonatal care and guidelines limiting iatrogenic late preterm birth.1,2 In 2024, the March of Dimes deemed the US as having a grade of "D+" for preterm birth, noting that preterm birth rates have steadily increased, with the state of Delaware similarly receiving a D+. 3 The predominant drivers of preterm birth are spontaneous preterm birth and iatrogenic delivery, mostly the result of preeclampsia, fetal growth restriction and maternal medical conditions associated with higher risks of stillbirth.
Author: Matthew K. Hoffman
Institution: Christiana Care Health System
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7123643116