Summary by Dr. Jen Mitchell

The U.S. Preventive Services Task Force (USPSTF) and American College of Obstetricians and Gynecologists (ACOG) guidelines changed in 2021 to help prevent preeclampsia. Low-dose aspirin has been shown to reduce the rate of preeclampsia. Modifications included guidelines that emphasized “lower income” status and Black racial identity (as a proxy for underlying systemic racism) as “moderate” risk factors for preeclampsia. They recommended patients in these demographics be more carefully monitored and take low-dose aspirin to reduce the risk of developing preeclampsia.

Researchers wanted to assess whether these modifications to the risk factors were associated with increased low-dose aspirin use in these groups after the new guidelines. They looked at over 31,000 first-time pregnant patients from 2017 to 2022 in one healthcare system. Two cohorts were created with patients matched exactly on other known risk factors for preeclampsia. The first cohort was stratified by Black and White race; the second cohort was stratified by private insurance and Medicaid insurance (as a proxy for lower income). The researchers found that low-dose aspirin use among patients who self-identified as Black increased by almost 9 percentage points compared to White patients. The rate of low-dose aspirin use among patients with Medicaid insurance did not increase relative to those with private insurance.

Researchers found that the 2021 USPSTF and ACOG guidelines helped increase aspirin use for Black patients, but not for “lower income” patients. Also, despite the new guidance, the overall rates of low-dose aspirin use remain significantly lower than expected. This issue arises from both clinicians not recommending low-dose aspirin sufficiently and patients not taking medication as prescribed. In short, not enough people who should be taking “baby aspirin” actually are.

This study has bearings on current care practices. It demonstrates that despite the revised guidance in 2021, overall rates of low-dose aspirin use are too low based on what is recommended by professional organizations. There is room for improvement in recommending low-dose aspirin for those at risk for developing preeclampsia.

Take home: Low-dose aspirin is indicated for the prevention of preeclampsia for patients with one or more high-risk factor or two-or more moderate risk factors. Recent guidelines emphasized the inclusion of Black race and low income as moderate risk factors. Healthcare providers should equally be talking with low-income patients about the potential benefits of aspirin if they have any additional moderate risk factors for preeclampsia. To learn more about your risk factors and how to ask your doctor about aspirin visit: https://preeclampsia.org/aspirin.

Citation:

Changes in Low-Dose Aspirin Use After Updated Guidance on Sociodemographic Risk Factors for Preeclampsia

Taylor S. Freret, MD, EdM, Allison S. Bryant, MD, Kaitlyn E. James, PhD, MPH, Anjali J. Kaimal, MD, MAS, Alexander Melamed, MD, MPH, and Mark A. Clapp, MD, MPH

https://journals.lww.com/ogopen/fulltext/2025/04000/changes_in_low_dose_aspirin_use_after_updated.2.aspx