Routine Aspirin Therapy Prevents Severe Preeclampsia in At-Risk Populations: New UT Southwestern Research

A groundbreaking study from the University of Texas Southwestern Medical Center has shown that routine aspirin therapy, initiated at the first prenatal visit, significantly reduces the risk of severe preeclampsia in at-risk pregnant populations. Led by Associate Professor Elaine L. Duryea, MD, this research offers compelling evidence for broader implementation of low-dose aspirin prophylaxis, potentially transforming maternal health outcomes in high-risk settings. 61 60

The findings, presented as a late-breaking oral abstract at the Society for Maternal-Fetal Medicine's (SMFM) 2026 Pregnancy Meeting and published in the February 2026 issue of Pregnancy, highlight a 29% reduction in severe preeclampsia cases among over 18,000 patients at Parkland Hospital in Dallas. This university-led initiative directly addresses longstanding challenges in preeclampsia prevention, where underutilization of proven therapies has persisted despite clear guidelines. 62

What Is Preeclampsia and Why Does It Matter?

Preeclampsia, a hypertensive disorder of pregnancy, is defined as new-onset high blood pressure (140/90 mmHg or higher) after 20 weeks of gestation, accompanied by proteinuria (300 mg or more in 24 hours) or evidence of end-organ dysfunction such as liver enzyme elevation, thrombocytopenia, renal insufficiency, pulmonary edema, or cerebral/visual symptoms. Severe preeclampsia (SPE) escalates this danger, involving blood pressure readings of 160/110 mmHg or greater, or severe organ involvement, making it a leading cause of maternal and fetal morbidity and mortality worldwide.

In the United States, hypertensive disorders like preeclampsia account for approximately 7.7% of pregnancy-related deaths as reported by the Centers for Disease Control and Prevention (CDC) in 2024 data. At-risk populations, particularly those served by public hospitals like Parkland, face disproportionately higher rates due to factors such as chronic hypertension, obesity, and socioeconomic barriers. This new research underscores the urgent need for accessible interventions in these communities. 62

Understanding the pathophysiology is key: Preeclampsia stems from abnormal placentation, leading to placental ischemia, endothelial dysfunction, and systemic inflammation. Low-dose aspirin works by inhibiting thromboxane A2 production in platelets, improving uteroplacental blood flow and reducing vasoconstriction.

The UT Southwestern Study Design: A Real-World Implementation

Researchers at the University of Texas Southwestern Medical Center implemented a universal aspirin protocol starting in August 2022 for all pregnant patients presenting for prenatal care at or before 16 weeks gestation at Parkland Health. Patients received 162 mg of daily aspirin directly dispensed in clinics—a strategy to boost adherence by eliminating prescription and pharmacy access barriers.

The study compared outcomes from 18,457 births between 2023 and 2025 (post-intervention) to a matched historical cohort of similar size pre-intervention. This observational before-and-after design captured real-world effectiveness in a diverse, high-risk population primarily comprising low-income and minority patients, reflecting broader U.S. demographics in safety-net hospitals. 61

• Inclusion: All singleton and multiple gestations initiating care ≤16 weeks.
• Intervention: 162 mg aspirin daily until delivery or 36 weeks.
• Primary Outcome: Incidence of SPE.
• Secondary: Timing of SPE onset, progression from chronic hypertension to SPE, maternal hemorrhage, placental abruption.

This approach mirrors pragmatic trials, providing actionable insights for clinical translation beyond randomized controlled trials (RCTs).

Key Results: 29% Reduction and Delayed Onset

The aspirin group experienced a striking 29% lower incidence of SPE (5.19% vs. 7.12%). Among those who developed SPE, onset occurred later in gestation, allowing more time for monitoring and intervention. Notably, patients with preexisting chronic hypertension—a major risk factor—were significantly less likely to progress to SPE.

Crucially, no increases in adverse events like maternal hemorrhage or placental abruption were observed, affirming aspirin's safety profile. 60

Dr. Elaine L. Duryea: Leading Maternal-Fetal Medicine Innovation

Elaine L. Duryea, MD, Associate Professor of Obstetrics and Gynecology at UT Southwestern and Chief of Obstetrics at Parkland Health, spearheaded this research. Her work builds on a career dedicated to improving outcomes in underserved populations. "Implementation of directly-dispensed aspirin appeared to delay the onset and, for some, completely prevent SPE," Dr. Duryea stated. 61

UT Southwestern's Department of Obstetrics and Gynecology is a powerhouse in maternal-fetal medicine research, training future leaders. Faculty like Dr. Duryea contribute to national guidelines and trials, positioning the university as a hub for research jobs in reproductive health.

Alignment with National Guidelines: USPSTF and ACOG

The U.S. Preventive Services Task Force (USPSTF) recommends low-dose aspirin (81 mg/day) after 12 weeks for high-risk women, based on meta-analyses showing 10-24% preeclampsia risk reduction. The American College of Obstetricians and Gynecologists (ACOG) echoes this, endorsing 81-162 mg doses.USPSTF Recommendation

This study supports escalating to 162 mg and universal screening/dispensing in high-risk clinics, potentially influencing updates. Risk factors include:

• Major: Prior preeclampsia, multifetal gestation, chronic hypertension, diabetes, renal disease, autoimmune disorders.
• Minor: Nulliparity, obesity (BMI ≥30), family history, Black race, IVF.

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Overcoming Adherence Barriers: The Direct-Dispensing Model

Despite guidelines, only 30-50% of eligible women receive aspirin due to cost, access, awareness, and compliance issues. Parkland's model—free on-site dispensing—achieved high uptake, demonstrating scalability in resource-limited settings. Step-by-step implementation:

1. Screen at first visit using checklists.
2. Assess contraindications (e.g., bleeding disorders).
3. Disperse 162 mg enteric-coated aspirin.
4. Educate on nightly dosing before 10 PM.
5. Follow-up adherence via pill counts.

This innovation, born from university-hospital collaboration, offers a blueprint for nationwide adoption. 62

Safety and Broader Impacts: No Harm Observed

Aspirin's antiplatelet effects raise hemorrhage concerns, but this large cohort showed no excess risk. Benefits extend to reduced preterm birth and fetal growth restriction in prior RCTs. For chronic hypertension patients, preventing SPE progression averts eclampsia, HELLP syndrome, and strokes.

Long-term, lower SPE could decrease NICU admissions and healthcare costs, vital for public systems. University researchers continue probing optimal dosing via trials like ASPIRIN at UNC. 59

University Research Ecosystem: Ohio State and Beyond

Complementing UT Southwestern, Ohio State Wexner Medical Center's PCORI-funded trial tests higher-dose regimens in 10,000+ patients through 2028, led by Maged Costantine and Kara Rood. Their work on placental biomarkers predicts aspirin response, advancing personalized medicine.

UCSF and Weill Cornell contribute RCTs comparing 81 mg vs. 162 mg. These higher ed institutions drive evidence-based care, creating professor jobs and postdoc opportunities in maternal health.

Challenges, Equity, and Global Relevance

While promising, generalizability to low-risk or private settings needs validation. Equity gaps persist: Black women face 60% higher preeclampsia rates. Direct-dispensing tackles access but requires policy support.

Internationally, similar benefits seen in Egyptian RCT with 75 mg early initiation. 63 U.S. universities lead in adapting for diverse populations.

Future Outlook: Trials and Guideline Evolution

Ongoing multi-site studies will clarify dosing (81 vs. 162 mg) and universal vs. targeted use. Integration with PlGF testing or AI risk models looms. UT Southwestern's success may prompt ACOG/SMFM updates, emphasizing early, universal prophylaxis in high-risk clinics.

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Photo by pina messina on Unsplash

Actionable Insights for Clinicians and Expectant Parents

Discuss aspirin with providers at first visit if high-risk. Monitor blood pressure routinely. Universities like UT Southwestern exemplify how academic research translates to lives saved. Stay informed via Rate My Professor for top MFM educators.

In summary, routine aspirin therapy represents a safe, effective strategy against SPE, propelled by university innovation. As evidence mounts, expect widespread adoption, reducing maternal mortality disparities.

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