Preeclampsia is a life-threatening pregnancy complication that continues to pose significant risks to maternal and fetal health worldwide. A recent study presented at the Society for Maternal-Fetal Medicine (SMFM) 2026 Pregnancy Meeting reveals that prescribing daily aspirin to all pregnant patients at their first prenatal visit may substantially reduce the incidence of severe preeclampsia, offering a potentially transformative approach for high-risk populations.
Preeclampsia is characterized by persistently elevated blood pressure and signs of organ damage, including proteinuria, liver dysfunction, and in severe cases, kidney failure or neurological complications. Severe preeclampsia, also referred to as preeclampsia with severe features, significantly increases the risk of maternal morbidity and mortality. In the United States, hypertensive disorders accounted for 7.7% of all pregnancy-related deaths in 2024, according to the Centers for Disease Control and Prevention (CDC) (CDC, 2025). Globally, preeclampsia remains one of the leading causes of maternal death, highlighting the urgent need for effective prevention strategies.
Early identification of preeclampsia typically involves monitoring blood pressure and clinical symptoms, including severe headaches, visual disturbances, and upper abdominal pain. Despite this, interventions to prevent preeclampsia have historically focused on high-risk populations, leaving many patients potentially vulnerable.
Low-dose aspirin therapy has been recognized as a preventive measure for preeclampsia, particularly for women identified as high-risk due to factors such as chronic hypertension, previous preeclampsia, or multiple gestation. When initiated between 12 and 28 weeks of gestation, aspirin has demonstrated benefits in reducing the incidence of preeclampsia. However, despite established guidelines, its use remains underutilized, often due to barriers in access, prescription practices, or patient adherence.
Recent guidelines from professional organizations, including SMFM, now advocate for consideration of universal low-dose aspirin administration in populations with a high prevalence of preeclampsia. This recommendation stems from accumulating evidence that broad-based prophylaxis may enhance maternal and fetal outcomes without introducing significant risks.
The study presented by Dr. Elaine L. Duryea, Associate Professor of Obstetrics and Gynecology at the University of Texas Southwestern Medical Center and Chief of Obstetrics at Parkland Health, examined the effects of universal aspirin therapy in a high-risk pregnant population at Parkland Hospital in Dallas, Texas. Beginning in August 2022, all pregnant patients who presented at or before 16 weeks’ gestation received 162 mg of aspirin daily, which was directly dispensed at prenatal clinics to eliminate common barriers to adherence.
Researchers compared outcomes for 18,457 patients who gave birth between 2023 and 2025 after the implementation of universal aspirin therapy with a similar number of patients from the period prior to aspirin use. The primary outcome of interest was the incidence of severe preeclampsia, while secondary outcomes included the timing of onset and maternal complications such as hemorrhage or placental abruption.
The results of this study were highly encouraging. Patients who received daily aspirin demonstrated a 29% lower rate of developing severe preeclampsia compared to the control group. Notably, among patients who still developed severe preeclampsia despite aspirin therapy, the onset occurred later in pregnancy, potentially reducing the risk of early preterm birth and improving neonatal outcomes.
Furthermore, patients with preexisting chronic hypertension who received aspirin were less likely to develop severe preeclampsia, suggesting that aspirin may provide particular benefits for individuals already at elevated risk. Importantly, the study found no significant increase in maternal hemorrhage or placental abruption, addressing longstanding concerns about potential safety risks associated with aspirin use during pregnancy.
Dr. Duryea emphasized the potential impact of these findings: “Implementation of directly-dispensed aspirin in this high-risk pregnant population appeared to delay the onset, and for some patients completely prevent the development of preeclampsia with severe features. While we cannot be sure that similar effects will be observed in other patient populations, there was no evidence of harm caused by aspirin administration.”
The oral abstract detailing this research, titled “Universal aspirin administration for prevention of preeclampsia,” was published in the February 2026 issue of PREGNANCY, the official peer-reviewed medical journal of the Society for Maternal-Fetal Medicine.
The implications of this study are profound for obstetric care providers, particularly in clinics serving high-risk populations. Directly dispensing aspirin at prenatal visits may enhance adherence and ensure timely initiation of therapy. Additionally, universal aspirin administration could simplify clinical decision-making, eliminating the need for complex risk stratification protocols that may delay prophylaxis.
This approach could also reduce disparities in maternal health outcomes. High-risk populations, including those with limited access to prenatal care or with socioeconomic challenges, often face higher rates of preeclampsia and related complications. Universal aspirin therapy provides a feasible, low-cost intervention that may mitigate these disparities and improve health equity.
Safety remains a critical concern in any preventive strategy. Historically, aspirin use during pregnancy was carefully restricted due to potential bleeding risks. However, low-dose aspirin, particularly at doses ranging from 81 to 162 mg daily, has been extensively studied and is generally considered safe for use after the first trimester. The SMFM study reinforces this safety profile, demonstrating no increase in maternal hemorrhage or placental complications among participants.
Pregnant patients should always consult their healthcare provider before initiating any medication, including aspirin, to ensure it is appropriate for their individual medical history and risk factors.
This study aligns with prior research on aspirin for preeclampsia prevention. Multiple meta-analyses have confirmed that low-dose aspirin can reduce the risk of preeclampsia by approximately 10 to 20% in high-risk populations, with benefits most pronounced when therapy is initiated early in the second trimester (Roberge et al., 2017; Bujold et al., 2010). The SMFM study expands on these findings by exploring universal administration in a large, diverse population and providing evidence for delayed onset of severe preeclampsia in addition to overall risk reduction.
The study also underscores the importance of adherence and accessibility. Direct dispensing at prenatal visits addresses a well-documented barrier in preventive medicine, ensuring that patients receive the therapy without delays associated with pharmacy access or prescription fulfillment challenges.
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The broader implications of universal aspirin therapy extend beyond individual patient outcomes. Reducing the incidence of severe preeclampsia can decrease rates of preterm birth, neonatal intensive care admissions, and long-term cardiovascular complications for mothers. Health systems may also benefit from reduced healthcare costs associated with managing severe preeclampsia and its complications.
By providing a simple, effective, and low-cost preventive measure, universal aspirin administration has the potential to shift standard prenatal care practices toward proactive, evidence-based interventions that improve both maternal and neonatal outcomes.
The 2026 SMFM study demonstrates that daily aspirin therapy, initiated at the first prenatal visit and directly dispensed to patients, significantly reduces the risk of severe preeclampsia in high-risk populations. This intervention delays the onset of disease for those who develop it, provides protection for patients with chronic hypertension, and does not increase maternal hemorrhage or placental complications.
As research continues to evolve, universal aspirin administration may become a cornerstone of prenatal care, particularly in populations with elevated preeclampsia risk. Healthcare providers and patients should remain informed about the latest guidelines and discuss individualized strategies for preventing this serious pregnancy complication.
This blog is intended for educational purposes only and is not a substitute for professional medical advice. Pregnant individuals should consult their healthcare provider before starting any medication, including aspirin, to determine the appropriateness and dosage based on individual health status and risk factors.
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