Disparities in low dose aspirin use for preeclampsia risk reduction and opportunities for improvement

Low-dose aspirin (LDA) is a safe, inexpensive, and evidence-based intervention that reduces the risk of preeclampsia among pregnant individuals at elevated risk. Despite strong evidence and national guideline recommendations, implementation of LDA prophylaxis remains inconsistent, and emerging evidence suggests that disparities in LDA use may contribute to inequities in maternal health outcomes. This review summarizes the current literature on disparities in LDA use for preeclampsia prevention and explores opportunities for equitable implementation. Existing studies demonstrate disparities across multiple stages of the LDA prevention pathway, including preeclampsia risk identification, clinician counseling and prescribing, patient uptake, and adherence. National data suggest that Black and Hispanic patients, publicly insured patients, non-English-speaking patients, and individuals receiving care in resource-constrained settings may be less likely to receive or use LDA prophylaxis. Patients eligible based on multiple moderate-risk factors appear particularly vulnerable to missed prescribing opportunities. Importantly, disparities persist even after LDA recommendation, highlighting the role of barriers related to trust, communication, health literacy, and structural determinants of health. Conceptualizing LDA delivery as a multistep implementation process provides a framework for understanding how inequities emerge and propagate throughout the care continuum. Emerging quality improvement and implementation initiatives suggest that standardized risk screening, electronic health record tools, clinician education, multilingual patient resources, workflow redesign, and team-based care approaches may improve equitable delivery of LDA prophylaxis. However, long-term outcome data remain limited. Addressing disparities in preeclampsia prevention will require equity-centered implementation strategies that move beyond guideline dissemination alone and focus on ensuring consistent delivery of evidence-based care across diverse patient populations.