Daily Aspirin May May Prevent Severe Preeclampsia in At-Risk Populations: Daily Dose

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On February 12, 2026, we reported on data presented at the Society for Maternal-Fetal Medicine (SMFM) 2026 Pregnancy Meeting™ that examined the effect of universal aspirin dispensation in a population where the majority of patients were at moderate or high risk of preeclampsia.

The study

Researchers conducted an inception cohort study that included all deliveries at a high-volume public hospital in Texas between April 2020 and July 2025. The population was characterized by a high prevalence of patients at moderate or high risk for preeclampsia. On August 3, 2022, the facility implemented a "universal aspirin" protocol. All patients presenting for prenatal care at ≤16 weeks gestation were directly dispensed 162mg of aspirin daily.

The primary outcome was the incidence of preeclampsia with severe features (SPE), defined clinically as severe hypertension or lab abnormalities requiring magnesium sulfate administration. Investigators used generalized estimating equations (GEE) with a logit link to compare SPE rates between epochs. Kaplan-Meier plots and log-rank tests were employed to analyze the "time to diagnosis," determining if universal aspirin delayed the clinical onset of severe features. Also, researchers specifically tracked secondary safety outcomes, including rates of neonatal intracranial hemorrhage (IVH), gastroschisis, placental abruption, and postpartum hemorrhage.

The results

Two cohorts of 18 457 patients, before and after aspirin implementation, were compared. Results showed that those in the aspirin epoch had a significantly lower rate of preeclampsia with severe features (5.19% vs. 7.12%; OR 0.71; 95% CI, 0.66–0.78; P < .001), with time to diagnosis also significantly delayed. The benefit held across subgroups: patients with chronic hypertension (OR 0.72; 95% CI, 0.60–0.87) and those without (OR 0.63; 95% CI, 0.57–0.70) both demonstrated significant reductions. Rates of postpartum hemorrhage, neonatal intraventricular hemorrhage, gastroschisis, and placental abruption did not increase; the rate of postpartum hemorrhage defined as blood loss greater than 1000 mL modestly decreased in the aspirin epoch (9.5% vs. 8.9%; P = .03).

Authors' comments

“Implementation of universal aspirin dispensation at the first prenatal visit was associated with a population-level reduction in the development of SPE in patients with and without chronic hypertension, without an increase in hemorrhage or abruption."

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