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Aspirin Prophylaxis for Preeclampsia Prevention in Nigeria: An Explanatory Sequential Mixed Methods Study
Zainab Mahmoud1, Laura Crook2, Chibundo Onyia3
1Department of Medicine, Cardiovascular Division and Global Health Center, Washington University in St Louis, St Louis, Missouri, USA; Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, Missouri, USA.
Journal of the American College of Cardiology
|December 3, 2025
Summary
Aspirin for preeclampsia prevention is underutilized in Nigeria. Targeted strategies are needed to improve maternal and fetal health outcomes by closing the evidence-practice gap.
Area of Science:
- Obstetrics and Gynecology
- Maternal Health
- Public Health
Background:
- Hypertensive disorders of pregnancy pose significant global risks to mothers and infants.
- Aspirin prophylaxis is evidence-based for preeclampsia prevention but underused, especially in low-resource settings.
Purpose of the Study:
- To assess aspirin utilization for preeclampsia prevention in Nigeria.
- To identify barriers and facilitators to aspirin uptake among at-risk pregnant individuals.
Main Methods:
- An explanatory sequential mixed methods study involving 1,200 pregnant participants in Nigeria.
- Preeclampsia risk assessed using WHO criteria; aspirin prescription rates and influencing factors analyzed quantitatively.
- Qualitative data from interviews and focus groups explored implementation barriers and facilitators.
Main Results:
- Only 23% of 359 at-risk participants reported aspirin use.
- Factors associated with higher aspirin prescription included prior preeclampsia, hypertension, employment, and higher income.
- Key barriers were lack of guidelines, late antenatal care, sociocultural norms, and limited provider knowledge.
Conclusions:
- Aspirin prophylaxis for preeclampsia is significantly underutilized in Nigeria.
- Urgent, targeted implementation strategies are required to bridge the evidence-practice gap and enhance maternal outcomes.
