Despite Guidelines, Aspirin Is Used in Fewer Than One in Four High-Risk Pregnancies

Why It Matters

The low adoption of a proven, inexpensive therapy leaves many women vulnerable to preventable maternal morbidity and future heart disease, exposing systemic failures in prenatal practice.

Key Takeaways

• Only 24% high‑risk pregnancies received aspirin by 2023.
• Aspirin use rose from 3% pre‑2014 to 24% in 2023.
• Renal and autoimmune disease patients less likely to get aspirin.
• Guideline adherence gaps stem from providers and systemic barriers.
• Effective, low‑cost aspirin could prevent preeclampsia and future CVD.

Pulse Analysis

Preeclampsia remains a leading cause of maternal complications, affecting roughly one in fourteen pregnancies and dramatically increasing the risk of cardiovascular disease in the months after delivery and later in life. Since 2014, the US Preventive Services Task Force has advocated low‑dose aspirin for anyone with high‑risk factors, positioning the drug as a low‑cost, low‑risk preventive measure that could curb both immediate obstetric outcomes and long‑term health burdens.

The Mass General Brigham cohort, spanning a decade of electronic health records, paints a stark picture: by 2023, just a quarter of eligible women were documented as having received aspirin. Uptake climbed from a mere 3‑4% before the recommendation to 10% after the American College of Obstetrics and Gynecology endorsement, yet stalled well below the target. Notably, patients with renal or autoimmune disease were even less likely to be prescribed aspirin, suggesting that provider bias or workflow gaps may disproportionately affect certain subpopulations.

These findings underscore a critical systems issue. Even when evidence is clear and the medication inexpensive, implementation falters without coordinated interventions—electronic prompts, provider education, and patient outreach can bridge the divide. Scaling such solutions could translate into measurable reductions in preeclampsia incidence, lower maternal mortality, and downstream cardiovascular savings. Stakeholders across health systems, insurers, and professional societies must prioritize embedding aspirin prescribing into routine prenatal protocols to realize its full public‑health potential.