‘The chemist kept telling me I should not take it despite my doctor’s advice.’


Conflicting information from pharmacists on the safety and indication for aspirin in pregnancy may negatively influence adherence, say researchers

Women with pre-existing medical comorbidities such as chronic hypertension, diabetes, autoimmune conditions, renal disease and previous preeclampsia have an increased risk of developing preeclampsia in their pregnancy.

Early initiation of aspirin, before 16 weeks of gestation, is strongly recommended in these women. This has been shown to reduce their risk of preeclampsia by 60-70%.

However researchers say conflicting information from pharmacists on the safety and indication for aspirin in pregnancy may negatively influence adherence for these women.

A recent study published in PLOS One identified pill burden and communication with healthcare providers as main factors that influence women’s adherence with aspirin in pregnancy.

Of 154 invitations sent out, 122 women (79%) completed the survey for the study led by Dr Renuka Shanmugalingam, a nephrologist and obstetric medicine physician from the South Western Sydney Local Health District in NSW.

Factors that had potential to negatively influence adherence with aspirin in pregnancy included inconsistent messaging among healthcare providers, especially from pharmacists, which was reported in 36 (30%) of women.

A sub-analysis of this study demonstrated that 54% of women discussed the use of aspirin with their pharmacist after the initial discussion with their clinician.

However, 38% of these women were unsatisfied with the outcome of their discussion with their pharmacist and this was predominantly in relation to conflicting information from pharmacists on the safety and indication for aspirin in pregnancy.

The importance of consistent communication was further corroborated by women who participated in the interviews:

The chemist kept telling me that I should not take aspirin while I was pregnant despite my doctor’s adviceThis made my husband and mother very concerned and they discouraged me from taking the aspirinMy husband was unhappy and came with me to my appointment to talk about this with my doctorMy doctor spent a lot of time to talk to us about it and put our mind at easeShe also called the chemist after we left.” (Interview participant 6aspirin adherent group,30 yo)

The chemist told me that I should not take aspirin while I was pregnant despite my doctor’s adviceThis made my husband very concerned and discouraged me from taking the aspirin (Interview participant 1aspirin non-adherent group29 yo)

 “When I was told by the first doctorI was still a bit sceptical and it’s only when I saw the second and third doctorit sunk in and I thoughtit must be important as they are all saying the same thingIt then made senseIt works well when doctors communicate the same thingit gives us confidence.” (Interview participant 2aspirin adherent group34 yo)

Dr Shanmugalingam said that consistent messaging between healthcare providers including pharmacists plays a crucial role in helping women understand the need for aspirin in their pregnancy and improves adherence with therapy.

“The current guidelines recommend the use of 150mg of aspirin (either ½ of 300mg of aspirin or 1 and ½ of non-coated aspirin) every night. Nocte dosing of aspirin is recommended based on the data that supports its chronotherapeutic effect,” she told AJP.

“Aspirin is commenced prior to 16 weeks of gestation and often ceased between 34-36 weeks of gestation. As with general aspirin use, high-risk pregnant women are advised to take aspirin with food to minimise gastrointestinal irritation.

In the event of uncertainty, it is strongly recommended that the pharmacist contacts the prescribing clinician to make clarifications.

“Recent data suggest that misinformation from pharmacist can negatively influence adherence with aspirin in pregnancy,” she emphasised.

Dr Shanmugalingam added that there are no contraindications for concurrent use of aspirin with other pregnancy safe medications.

“However, women who are on aspirin in addition to other anticoagulants, such as enoxaparin should be made aware of the increased risk of bleeding – this concurrent use, however, is often a strong medical indication in conditions such as antiphospholipid syndrome. Any uncertainty on the indication for should be discussed directly with the treating clinician,” she said.

AJP has published a CPD activity ‘Pre-eclampsia and the use of aspirin in its prevention’ this month, written by Dr Renuka Shanmugalingam, Professor Annemarie Hennessy and Dr Angela Makris.

Find out more and access the CPD activity on pre-eclampsia and the use of aspirin here

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