Clinical and geographical variation in prophylactic and therapeutic treatments for pre‐eclampsia in the UK

Please cite this paper as: Chappell L, Seed P, Enye S, Briley A, Poston L, Shennan A. Clinical and geographical variation in prophylactic and therapeutic treatments for pre‐eclampsia in the UK. BJOG 2010; DOI: 10.1111/j.1471‐0528.2010.02507.x. Objective  To evaluate the clinical and geographical variation in the use of aspirin in women at high risk of pre‐eclampsia, and in the use of antihypertensive drugs and magnesium sulphate in women with established pre‐eclampsia. Design  Analysis of vitamins in pre‐eclampsia (VIP) trial database. Sample  A total of 2399 women at increased risk of pre‐eclampsia in 25 UK hospitals. Methods  An analysis of a large prospectively validated database of high‐risk women in the UK was undertaken to assess aspirin use across different risk groups and to evaluate the use of antihypertensives and magnesium sulphate in 370 women who developed pre‐eclampsia. Logistic regression was employed to compare drug use between region and by recognised clinical indicators. Main outcome measures  Usage of aspirin, antihypertensive drugs and magnesium sulphate. Results  Of the women with known risk factors at trial entry, 24% (569/2399) received low‐dose aspirin. Aspirin usage varied widely between risk groups [from 5% (19/378) in women with multiple pregnancy to 94% (50/53) in women with antiphospholipid syndrome] and between geographical regions [from 8% (20/248) to 49% (95/193)]. Three hundred and seventy women developed pre‐eclampsia, 52% ( n  = 193) of whom received new or additional antihypertensives after 20 weeks of gestation; 34% (77/224) with a maximum recorded systolic blood pressure of ≥160 mmHg in the second half of pregnancy did not receive antihypertensive treatment; 17% (62/370) of women with pre‐eclampsia received magnesium sulphate prophylactically. Conclusions  Prophylactic and treatment regimes for pre‐eclampsia in the UK vary by region and risk group.