Aspirin Prophylaxis for Preeclampsia Prevention in Nigeria: An Explanatory Sequential Mixed Methods Study.

Abstract

Hypertensive disorders of pregnancy are leading causes of maternal and fetal morbidity and mortality globally. Despite robust evidence supporting aspirin prophylaxis for preeclampsia prevention, it remains underutilized, particularly in low- and middle-income countries. The purpose of this study was to evaluate aspirin utilization among pregnant individuals at moderate to high risk for preeclampsia in Nigeria and identify multilevel barriers and facilitators to its uptake using an explanatory sequential mixed methods approach. A total of 1,200 pregnant participants were enrolled from 4 tertiary care hospitals between October 2023 and March 2024. Preeclampsia risk stratification was based on WHO criteria. Quantitative data assessed rates and factors associated with aspirin prescription. In-depth interviews and focus group discussions with 62 participants were conducted between August 2024 and November 2024, guided by the Consolidated Framework for Implementation Research 2.0. Of 1,159 participants with complete risk profiles, 30 (3%) were moderate-risk and 329 (28%) were high-risk for preeclampsia. The mean age was 30 ± 6 years. Among 359 at-risk participants, 84 (23%) reported aspirin use. Odds of aspirin prescription were higher with prior preeclampsia (OR: 4.68; 95% CI: 2.42-9.07), gestational hypertension (OR: 2.42; 95% CI: 1.25-4.67), chronic hypertension (OR: 2.08; 95% CI: 1.01-4.29), and among employed and higher-income individuals. Barriers included lack of standardized national guidelines, late antenatal presentation, sociocultural norms, and limited provider knowledge. Facilitators included provider motivation, perceived ease of workflow integration, and institutional support. Aspirin prophylaxis for preeclampsia remains underutilized in Nigeria. Targeted implementation strategies are urgently needed to close the evidence-practice gap and improve maternal outcomes.