A new study out of Parkland Health and UT Southwestern could change how healthcare providers prevent one of the leading causes of infant and maternal mortality and morbidity.

Preeclampsia, a condition that involves "dangerously" high blood pressure during pregnancy, can lead to seizures, stroke or even death for both the parent and the child if left untreated. Parkland and UT Southwestern researchers found that prescribing every pregnant patient a daily low-dose aspirin tablet at their first prenatal visit led to a "significant drop" in severe preeclampsia.

"One thing that this might do is move the needle and make physicians and other providers more comfortable giving aspirin to a larger population who could benefit from it," said Dr. Elaine Duryea, chief of obstetrics at Parkland and associate professor of Obstetrics and Gynecology at UT Southwestern.

Decrease in severe preeclampsia

Over the length of the study, the rate of severe preeclampsia went from about 7% to about 5% of pregnant Parkland patients.

"It does not seem perhaps like a huge change, but clinically it is a very large difference," Duryea said. "As an institution that delivers over 13,000 babies a year, if you start doing the math, you realize that's a very large number of patients that won't suffer from these severe complications and can have a safer, more routine delivery."

The study, published in the American Journal of Obstetrics and Gynecology in August, looked at more than 36,000 deliveries at Parkland Memorial Hospital from 2020 to 2025 – before and after the hospital started universally prescribing aspirin. The medication was prescribed to patients who started receiving prenatal care before they were 16 weeks into their pregnancy, since previous research doesn't show a benefit for people who start taking aspirin later.

Even though aspirin didn't outright prevent every patient from developing preeclampsia, Duryea said it was typically much less severe and developed later in the pregnancy. The rate of severe complications dropped by more than 25%.

The effect wasn't exclusive to just one demographic group. Duryea said it worked whether patients had chronic hypertension or not, and across every race and ethnicity studied.
One of the most important things the study found, according to Duryea, was that there were no severe adverse effects as a result of taking the medication daily.

"With 18,000 women taking aspirin, there was no harm to taking it that we could detect," she said.

Going from no recommendation to a universal one

Parkland didn't have a recommendation for patients to take aspirin as prevention for conditions like preeclampsia until 2022.

Before then, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine recommended a screening approach that identifies patients who are considered high risk for the condition based like prior medical conditions, family history and socioeconomic status. Aspirin was then prescribed based on the results.

"That risk screening can be quite cumbersome," Duryea said. "A lot of patients may not know extensive family history. It does have a lot of challenges and shortcomings. And at our institution, it was really difficult for us to implement."

Duryea said a lot of studies have showed most healthcare facilities aren't great at implementing the screening in a widespread fashion – meaning some patients who would have been considered "moderate to high risk" weren't identified.

Then, at the end of 2021, the two professional associations that created the screening provided additional guidance that said universal aspirin may be a reasonable approach for institutions where most of the patients may be at high or moderate risk for preeclampsia.

Duryea estimates over 90% of Parkland's pregnant patients qualified for aspirin under new criteria that recommended it for more moderate risk factors – making universal aspirin the best approach.

"When that guideline came out, we all sat in a room and we said 'that, we can do really well,'" she said. "We are really good at implementing a system-wide initiative in a way that is really easy for patients and providers."

Because Parkland Memorial Hospital has such a high volume of deliveries, Duryea said it was possible to get a clearer picture of how much this approach works on a population level. She said there still needs to be more analysis done in other communities and nationwide to strengthen the research.

Duryea said she and her team are interested in expanding the effort across North Texas to see if they can demonstrate the same benefit in a larger population.

"As far as treatment, I hope that other similar institutions can look at this and see if it's a good fit for them," she said, "especially places that are struggling with consistently implementing risk-based screening and treatment."

Abigail Ruhman is KERA's health reporter. Got a tip? Email Abigail at aruhman@kera.org.

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