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Changes in Low-Dose Aspirin Use After Updated Guidance on Sociodemographic Risk Factors for Preeclampsia
Taylor S Freret1, Allison S Bryant1, Kaitlyn E James1
1Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, the Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts; and the Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida.
O&G Open
|September 26, 2025
Summary
New guidelines increased low-dose aspirin use in Black patients but not those with public insurance for preeclampsia prevention. Overall use remains low despite updated recommendations.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Health Services Research
Background:
- Preeclampsia is a significant cause of maternal morbidity and mortality.
- Recent guideline updates from the U.S. Preventive Services Task Force (USPSTF) and American College of Obstetricians and Gynecologists (ACOG) in 2021 incorporated race and income as risk factors.
- These updates aimed to address disparities in preeclampsia incidence and outcomes.
Purpose of the Study:
- To evaluate the impact of the 2021 USPSTF and ACOG guideline modifications on low-dose aspirin use among Black patients and those with lower income (proxied by Medicaid insurance).
- To assess if these guideline changes effectively increased the uptake of preventive low-dose aspirin in identified at-risk populations.
Main Methods:
- A repeated cross-sectional analysis was conducted on nulliparous patients delivering from 2017 to 2022 within a single healthcare system.
- Two matched cohorts were established: one stratified by race (Black vs. White) and another by insurance status (Medicaid vs. private).
- Difference-in-difference analyses were used to compare low-dose aspirin use rates before and after the 2021 guideline changes.
Main Results:
- The study included over 31,000 participants across race and income cohorts.
- Low-dose aspirin use increased by 8.8 percentage points among Black patients compared to White patients.
- No significant increase in low-dose aspirin use was observed among patients with Medicaid insurance compared to those with private insurance.
Conclusions:
- The 2021 USPSTF and ACOG guidelines were associated with increased low-dose aspirin use in Black patients, suggesting a positive impact on addressing racial inequities.
- However, the guidelines did not lead to a similar increase in low-dose aspirin use for patients with public insurance.
- Despite guideline updates, overall rates of low-dose aspirin use for preeclampsia prevention remain suboptimal.
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