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Universal vs risk-based aspirin prophylaxis in pregnancy: Time for a paradigm shift?
Maura Jones Pullins1, Kim Boggess1
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Seminars in Perinatology
|May 21, 2026
Summary
Low-dose aspirin effectively prevents preeclampsia and maternal complications. Universal prophylaxis, rather than risk-based strategies, may improve implementation and equity in preventing this condition.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Pharmacology
Background:
- Low-dose aspirin is proven to reduce preeclampsia risk.
- Current U.S. guidelines use risk-based aspirin prophylaxis.
- Risk stratification may miss many patients who develop preeclampsia.
Purpose of the Study:
- Evaluate evidence for low-dose aspirin in preeclampsia prevention.
- Assess limitations of current risk-based strategies.
- Explore benefits and harms of universal aspirin prophylaxis.
Main Methods:
- Literature review of studies on low-dose aspirin for preeclampsia.
- Analysis of current risk-based guidelines and their implementation.
- Comparative evaluation of risk-based versus universal prophylaxis models.
Main Results:
- Low-dose aspirin significantly lowers preeclampsia incidence and maternal morbidity.
- Risk-based strategies have inconsistent implementation and may under-identify at-risk individuals.
- Universal prophylaxis presents a simpler, more equitable approach.
Conclusions:
- Universal low-dose aspirin prophylaxis for preeclampsia offers advantages in simplicity, equity, and implementation over current risk-based methods.
- Consideration of universal aspirin is warranted to improve maternal outcomes.
- Further research may explore optimal implementation strategies for universal prophylaxis.
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