Patients’ perspective on aspirin during pregnancy: a survey

Figures & data

Table 1. Overview of the questions of the survey

Obstetric history
Question	Answers	Nature of question
1. What is your age?		Open question
2. Which of the following complications is applicable to your previous pregnancy/-ies?	a. Preeclampsia b. HELLP syndrome c. Eclampsia d. Combination of pre-eclampsia, HELLP syndrome and/or eclampsia e. Premature delivery before 34 weeks of gestation	Multiple choice, multiple answers possible
3. How many times have you been pregnant?		Open question
4. How many miscarriages have you had (gestation up to 12 weeks)?		Open question
5. In which year(s) did you deliver?		Open question
6. In which year(s) was your pregnancy complicated by pre-eclampsia, HELLP syndrome and/or eclampsia?		Open question
7. Do you have an active desire to have children?		Open question
Women’s knowledge about aspirin as riskreducing therapy
8. Have you been informed about aspirin as risk-reducing medicine for pre-eclampsia and HELLP syndrome in a consecutive pregnancy?		Open question
9. If you were informed about aspirin as risk-reducing medicine, by whom were you informed?	a. Gynecologist b. Midwife c. General practitioner d. Dutch HELLP Foundation e. Other	Multiple choice, one answer possible
Preferences of counseling about aspirin as risk-reducing therapy in timing, method and caregiver informing
10. What is your preference about the timing of informing? Multiple choice, one answer possible.	a. Before the first pregnancy b. During the pregnancy which was complicated by preeclampsia, HELLP syndrome and/or eclampsia c. At the postpartum checkup of the complicated pregnancy d. During clotting analysis e. During a preconception counseling f. At the beginning of the consecutive pregnancy g. No preference	Multiple choice, one answer possible
11. From whom do you prefer receiving the information?	a. Gynecologist b. Midwife c. General practitioner d. Vascular medicine specialist e. No preference	Multiple choice, one answer possible
12. How would you like to be informed?	a. Orally b. Written c. Orally as well as written	Multiple choice, one answer possible
Attitude toward drugs in general, during pregnancy and aspirin during pregnancy
13. What is your attitude about drug use in general?	a. No objection to take drugs b. Neutral c. Prefer not to take medicine	Multiple choice, one answer possible
14. What is your attitude about drug use during pregnancy?	a. Positive, if advised by my gynecologist b. Neutral c. Fear of the health of my unborn baby, even if reassured by my gynecologist	Multiple choice, one answer possible
15. Did you take aspirin during a previous pregnancy?	a. Yes b. No	Multiple choice, one answer possible
If question 15 was answered with “yes,” questions 16–19 were asked.
16. Did you take aspirin daily?	a. Yes b. No c. Don’t know	Multiple choice, one answer possible
17. Have you been advised to take aspirin in the evening?	a. Yes b. No c. Don’t know	Multiple choice, one answer possible
18. Did you experience side effects of the aspirin?	a. Yes b. No c. Don’t know	Multiple choice, one answer possible
19. With the knowledge of aspirin as risk-reducing medicine, would you take aspirin daily in the evening in a consecutive pregnancy?	a. Yes b. No c. Don’t know	Multiple choice, one answer possible
Women’s suggestions on the optimal timing of counseling, counseling daughters of women who have had HDP, and method of counseling
20. Do you think that aspirin should be prescribed to all women with a first pregnancy who have risk factors for developing pre-eclampsia and/or HELLP syndrome?	a. Yes b. No c. Don’t know	Multiple choice, one answer possible
21. Do you think that aspirin should be prescribed to all women with a first pregnancy without risk factors for developing pre-eclampsia and/or HELLP syndrome?	a. Yes b. No c. Don’t know	Multiple choice, one answer possible
22. Daughters of women with a history of pre-eclampsia, HELLP and/or eclampsia are at risk to develop these complications as well. Do you think that they should be informed about aspirin as risk-reducing medicine?	a. Yes b. No c. Don’t know	Multiple choice, one answer possible
23. Do you have any suggestions for the timing of informing about using aspirin as risk-reducing therapy in a consecutive pregnancy?		Open question
24. Do you have any suggestions for the timing of informing daughters of women with a history of pre-eclampsia, HELLP syndrome and/or eclampsia about aspirin as risk-reducing therapy?		Open question
25. Do you have any other suggestions for optimizing the informing process about aspirin as risk-reducing therapy?		Open question

The questions of the survey to participants of the Dutch HELLP Foundation grouped in five themes, depicted in bold. The question, the possible answers, and the nature of the question are listed. Questions are translated to English. The original survey is in Dutch.

Table 2. Baseline characteristics of women with a history of hypertensive disorder of pregnancy

	n = 189
Age (years)	35.8 ± 7.3
Parity	2.1 ± 1.2
Previous* Preeclampsia Eclampsia HELLP Combination of above Preterm delivery	52 (29.6) 9 (5.1) 95 (54.0) 74 (42.1) 61 (32.3)
Year of previous pregnancies** > 2015 2011–2015 2006 – 2010 2000–2005 < 2000	55 (29.1) 135 (71.4) 50 (26.5) 34 (18.0) 43 (22.8)
Year of pregnancy complicated with HDP >2015 2011–2015 2006 – 2010 2000–2005 < 2000	42 (22.2) 85 (45.0) 28 (14.8) 16 (8.5) 18 (9.5)
Number of miscarriages	0.4 ± 0.7
Active desire to have children Yes No Maybe No answer	75 (39.7) 101 (53.4) 8 (4.2) 5 (2.7)

Data are depicted as mean ± SD or numbers (%) as appropriate.

* Total percentage ˃100% because of possible combinations of diagnoses.

** Total percentage ˃100% because some women had more than one previous pregnancy.

HELLP, hemolysis elevated liver enzymes low platelets; HDP, hypertensive disorders of pregnancy.

Table 3. Preferences of counseling concerning women with a history of hypertensive disorder of pregnancy

	n = 189
Would like to receive information by Gynecologist Midwife General practitioner Vascular medicine specialist/internist No preference No answer	150 (79.4) 18 (9.5) 10 (5.3) 4 (2.1) 5 (2.6) 2 (1.0)
Timing of informing Before first pregnancy During pregnancy complicated by HDP Postpartum checkup Outcome clotting analysis Preconception counseling Beginning of consecutive pregnancy No preference/other No answer	1 (0.5) 29 (15.3) 80 (42.3) 2 (1.0) 6 (3.2) 58 (30.7) 11 (5.8) 2 (1.0)
Method of informing Orally Written Orally as well as written No answer	56 (29.6) 11 (5.8) 118 (62.4) 4 (2.1)
Counseling nulliparous women at risk Yes No Don’t know No answer	148 (78.3) 9 (4.8) 26 (13.8) 6 (3.2)
Counseling first grade female family members Yes No Don’t know No answer	159 (84.1) 3 (1.6) 21 (11.1) 6 (3.2)
Counseling nulliparous women not at risk Yes No Don’t know No answer	42 (22.2) 96 (50.8) 45 (23.8) 6 (3.2)

Data are depicted as numbers (%).

HDP, hypertensive disorders of pregnancy.

Table 4. Attitude toward drug use in general and aspirin specific outside and during pregnancy

	n = 189
Attitude toward drug use in general No objection Neutral Prefer not to take medicine No answer	37 (19.6) 86 (45.5) 63 (33.3) 3 (1.6)
Attitude toward drug use during pregnancy Positive, if advised by gynecologist Fear of health fetus, even if reassured by gynecologist No answer	158 (83.6) 28 (14.8) 3 (1.6)
Aspirin previous pregnancy Daily intake* Advice intake in evening * Side effects* Motivated for daily aspirin intake in the evening during a possible consecutive pregnancy*	84 (44.4) 78 (92.9) 16 (19.1) 8 (9.5) 75 (89.3)

Data are depicted as numbers (%).

* Percentage of women who used aspirin in previous pregnancy (n = 84). Total percentage ˃100% because of more answers possible.