Health systems where most pregnant patients have a high or moderate risk for preeclampsia may benefit from universal dispensation of aspirin, results from a large cohort study suggested.
The rate of preeclampsia with severe features at a Texas health system was a relative 29% lower after it implemented universal aspirin dispensation in prenatal care compared with the period when aspirin was not recommended, regardless of risk factors (5.2% vs 7.1%; OR 0.71, 0.66-0.78, P<0.001), Elaine Duryea, MD, of University of Texas Southwestern Medical Center in Dallas, reported here.
Rates of all gestational hypertensive disorders were lower after implementation (19% vs 21%, P<0.0001), and the subgroup of women with chronic hypertension also had lower rates of preeclampsia with severe features (27.1% vs 34%, P<0.001), she detailed during a presentation at the Society for Maternal-Fetal Medicine (SMFM) annual meeting.
There were no changes in neonatal outcomes or abruption with the universal aspirin dispensation approach, and postpartum hemorrhage rates slightly decreased, from 9.5% before the intervention to 8.9% afterward.
"Implementation of directly-dispensed aspirin in this high-risk pregnant population appeared to delay the onset, and for some patients completely prevent the development of preeclampsia with severe features," Duryea said in an SMFM press release. "While we cannot be sure that similar effects will be observed in other patient populations, there was no evidence of harm caused by aspirin administration."
Preeclampsia is a leading cause of maternal morbidity and mortality, and preeclampsia with severe features is life-threatening. The American College of Obstetricians & Gynecologists (ACOG), SMFM, and the U.S. Preventive Services Task Force all recommend low-dose aspirin when one major or multiple moderate risk factors for preeclampsia are present. However, ACOG and SMFM released a practice advisory in 2021 that said for institutions where a majority of patients are at high or moderate risk for preeclampsia, offering low-dose aspirin to all patients "may be medically reasonable."
David Hackney, MD, a maternal-fetal medicine doctor at Case Western Reserve University in Cleveland, who was not involved in the research, said a noteworthy element of the study design was actually giving patients the aspirin, which removes barriers to access. Plus being universal means things inherently go smoother.
"The advantage of universal aspirin is that you're going to have a much higher rate of successfully getting it to the high-risk patients who need it," Hackney said. Importantly, this study did not find harm among patients who may be lower risk.
Hackney also noted that while not all health systems can do universal dispensation, the next best option would be an automatic trigger to order aspirin at the pharmacy alongside prenatal vitamins.
The study took place at Parkland Health, a level IV maternal care center that handles more than 13,000 deliveries each year. There are 10 community-based clinics that see more than 160,000 prenatal visits annually and have in-clinic pharmacies. A majority of patients at Parkland Health are Hispanic or Black, and insured by Medicaid.
The health system implemented universal aspirin dispensation in August 2022 and began giving bottles of enteric-coated low-dose aspirin tablets at the first prenatal visit, and instructed patients to take two (162 mg) every night alongside a prenatal vitamin (that was also supplied) for the duration of the pregnancy. They also distributed educational handouts.
To determine if universal aspirin dispensation reduced the rate of preeclampsia with severe features, researchers looked at all deliveries at Parkland Health from April 2020 to July 2025 where the patient presented for prenatal care by 16 weeks' gestation. They compared the period before universal implementation and the period after, with a 6-month washout period in between the two epochs.
The primary outcome was a diagnosis of preeclampsia with severe features at any time during or following pregnancy. Secondary outcomes included gestational age at delivery, gestational age at diagnosis of preeclampsia, postpartum hemorrhage, placental abruption, and neonatal outcomes. These outcomes were obtained from a quality assurance database.
Among the delivery characteristics and neonatal outcomes, the researchers found a slightly lower rate of preterm birth (<37 weeks) in the aspirin period (9% vs 10%, P=0.006), but a slightly higher rate of extremely preterm birth (<28 weeks; 0.9% vs 0.7%, P=0.013) and rate of admission to neonatal intensive care (10% vs 7%, P<0.001).
In all, 18,457 deliveries were analyzed before universal aspirin dispensation and the same number after. Patients in the aspirin group were less likely to be non-Hispanic Black (10% vs 14%), had a higher body mass index (28.7 vs 28.3), and were more likely to be nulliparous (31% vs 29%). The time to diagnosis of preeclampsia with severe features was longer in the aspirin group.
The study was limited by its observational nature and by using medication dispensation as a proxy for consumption.
Disclosures
Duryea and co-investigators did not state any disclosures.
Hackney had no disclosures.
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