More Pregnant Patients Now Benefit From Low-Dose Aspirin

Medscape

19-05-2025

Changing the prescribing protocol for low-dose aspirin (LDA) for preeclampsia prevention from risk-based to universal significantly increased aspirin use in pregnant patients, based on new data presented at the American College of Obstetricians and Gynecologists (ACOG) 2025 Annual Meeting.
The use of LDA to reduce the risk for preeclampsia has been well established as an inexpensive and simple intervention, but it has remained underutilized nationwide, said lead author Meryl Y. Grimaldi, MD, of SBH Health System, New York City, in an interview.
'Many of the patients we care for at SBH Health are at high risk for preeclampsia, but we wanted to ensure that our eligible patients received the benefits of this intervention,' said Grimaldi, who presented the study at the meeting.
A low rate of LDA use, defined as 25%-50% of eligible patients, is considered a quality gap by the Society for Maternal-Fetal Medicine, Grimaldi and colleagues noted in their abstract. The current ACOG criteria for use of LDA to prevent preeclampsia include not only high-risk patients but also women with more than one of the following moderate risk factors: First pregnancy, maternal age ≥ 35 years, body mass index > 30, family history of preeclampsia, sociodemographic characteristics, and personal history.
'We hypothesized that the majority of our patients were eligible to receive low-dose aspirin to prevent preeclampsia, but I was surprised that the rate was so high at more than 96%,' Grimaldi told Medscape Medical News . Moving from risk-based to universal recommendations increased the rates of prescribing LDA, she said.
In the study, Grimaldi and colleagues reviewed data from charts of 116 patients with a gestational age of 12-28 weeks between February 2024 and May 2024 at a single center. The researchers assessed the charts for preeclampsia risk factors, eligibility for aspirin based on ACOG guidelines, and whether aspirin was prescribed. A policy of universal prescribing of LDA for preeclampsia prevention began in 2023.
Prior to this change, LDA prescriptions were risk-based and for approximately 30% of patients, then increased to 46% of patients shortly after the shift to universal prescribing. During the study period, use of LDA increased to 81% overall and 88% in patients with high-risk factors.
We assumed universal candidacy was an effective intervention, as indicated by the increased prescribing rates, Grimaldi told Medscape Medical News . Similarly, high-risk populations might benefit from this universal approach to other prenatal care practices, she added.
'This change in practice would not be applicable to a population at lower risk for preeclampsia,' Grimaldi told Medscape Medical News . 'Other approaches, such as EMR [electronic medical record] practice advisories, patient and provider education, and patient questionnaires, can be utilized where universal implementation is inappropriate,' she said.
'Based on our population, we developed a quick screener that could detect most eligible patients with four demographic factors that are in the medical record; this would also be an option to explore,' Grimaldi noted.
Success Story Inspires Further Research
Administration of LDA has been shown to reduce the risk for preeclampsia, especially preterm preeclampsia, and this risk continues to rise with the increased risk for hypertension, obesity, and diabetes in the pregnant population, said Aleksandr M. Fuks, MD, professor and chair of the Department of Obstetrics & Gynecology at East Tennessee State University, Johnson City, Tennessee, in an interview.
'Aspirin, being essentially the only medication available to reduce the risk of preeclampsia, represents a unique opportunity for healthcare professions to improve maternal and neonatal outcomes in pregnancy,' he said.
The current study showed a significant increase in the use of LDA in the study population, and although the program's success was not unexpected, Fuks commended the study authors on their implementation of an important quality care initiative.
However, the barriers to increasing use of LDA as preeclampsia prevention include not only patient access to prenatal care and compliance with medication intake, but also late initiation of prenatal care, as administration of aspirin beyond the early weeks of the third trimester has not shown a significant effect on preeclampsia prevention, Fuks said.
'The possible solution includes patient education with respect to timely and early initiation of prenatal care, patient education regarding risks of preeclampsia and the role of aspirin in its prevention, outreach efforts to communities, and preconception counseling with emphasis on patients' comorbidities and associated disorders in pregnancy and their prevention,' Fuks added.
The main limitation of the study is its retrospective design, relatively small inclusion period, and the inability to address the secondary goal of reduction in the development of preeclampsia in the study population, Fuks told Medscape Medical News .
Future research should focus on the analysis of the rate of preeclampsia in the study population who initiated LDA and comparison to retrospective or concurrent cohorts of patients who had only baseline rates of LDA use, said Fuks. 'A larger time interval and multicenter design may be helpful in validating the results of the study and to assess receptivity of different population groups to early initiation of low-dose aspirin during pregnancy,' he said.