Guideline Implementation Gap in Preeclampsia Prevention: Adherence to Low-Dose Aspirin Use in Routine Obstetric Practice

Evidence-based guidelines recommend the use of low-dose aspirin (LDA) to prevent preeclampsia. Gaps between recommended and actual care may limit the impact of proven preventive interventions. This study aimed to assess obstetricians' adherence to LDA prescription for preeclampsia prevention in accordance with the national guideline. This retrospective cohort study included 1150 women who delivered between November 2023 and December 2024. Eligibility for LDA use was determined according to guideline-defined risk criteria. Adherence was defined as prescribing LDA between 11 and 16 weeks of gestation. The rate of LDA recommendation was assessed and factors associated with LDA prescription were analyzed. 210 women (18.3%) met the criteria for LDA recommendation. However, LDA was prescribed to 97 (46.2%) of these women, indicating that more than half of the candidates missed the opportunity for prophylaxis. Among the 969 women who did not use LDA during pregnancy, 113 (11.7%) actually met the guideline criteria and should have received LDA. In this untreated group, the incidence of preeclampsia was approximately fourfold higher compared with women without an LDA indication (26.5% vs. 8.2%; OR 4.06, 95% CI 2.50-6.58, p < 0.001). Follow-up at a tertiary healthcare center at or before 16 weeks of gestation was associated with significantly higher rates of appropriate LDA prescription (p < 0.001). Adherence to national guideline for the prevention of preeclampsia remains suboptimal in Türkiye. This implementation gap represents missed opportunities for the prevention of preeclampsia and underscores the need for targeted educational initiatives and system-level interventions.