Disparities in low-dose aspirin prescription among patients at risk for preeclampsia.

Objective: Low-dose aspirin (LDA) reduces preeclampsia risk, yet prescribing rates among eligible pregnant patients remain low. This study aims to determine whether there are disparities in LDA prescription to eligible patients based on race/ethnicity, primary language, or insurance after implementation of a standardized electronic health record (EHR) preeclampsia risk screening tool. Study design: This retrospective cohort study included all patients ≥ age 18 with births at a single academic center from September 2022 to July 2025 who had 1 high or ≥2 moderate preeclampsia risk factors. The primary outcome was rate of LDA recommendation/prescription, determined by recommendation documentation in the risk screening tool or prescription in the EHR medication log. Data were extracted from Epic Clinical Data Warehouse. Chi-square or Results: Of 5737 LDA-eligible patients, 3995 (69.6%) were recommended/prescribed LDA and 1742 (30.4%) were not. Patients recommended/prescribed LDA were more likely to be older, multiparous, English speaking, and privately insured and/or have pregestational diabetes or chronic hypertension, as well as high-risk factors for preeclampsia ( Conclusions: After implementation of a standardized preeclmapsia risk screening tool, LDA was more often prescribed to eligible Black patients than White, likely reflecting ACOG's inclusion of Black race as a proxy for racism as a preeclmapsia risk factor. However, LDA was less often prescribed to publicly insured or non-English speaking patients, which highlights an opportunity for quality and equity improvement.