Podcast Summary: Dr. Chapa’s OBGYN Clinical Pearls

Episode: More Support for 162mg LDA Universal Use in OB
Date: February 16, 2026
Host: Dr. Chapa
Audience: Medical students, residents, and healthcare providers in women’s health

Main Theme

Overview

This episode discusses new evidence supporting the universal use of a higher dose (162mg) of low-dose aspirin (LDA) in pregnancy—rather than selective, risk-based prescribing—and explores recent data presented at the 2026 SMFM (Society for Maternal-Fetal Medicine) meeting in Las Vegas. The discussion centers on who should receive LDA and at what dose, focusing on a major study from UT Southwestern.

Key Discussion Points and Insights

1. The Two Major Questions in Aspirin Use for Preeclampsia Prevention

• Who should receive low-dose aspirin in pregnancy?

  • Universal vs. risk-based approach
  • Current ACOG/SMFM guidance: give to women with one or more high-risk factors or two or more moderate-risk factors
  • Debate exists; some, including Dr. Chapa, favor universal dosing due to low risk and potential benefit

• What is the optimal dose?

  • US standard: 81mg (one baby aspirin)
  • International (e.g., UK): 150mg (2 x 75mg tablets)
  • Dr. Chapa advocates for 162mg (2 x 81mg tabs), reflecting a “dose-response” effect in preeclampsia prevention

“The two areas of controversy that are perpetual...is who gets this and at what dose should we get this, right? So those are the two controversies.”
— Dr. Chapa [06:19]

2. Evidence Review: Benefits & Safety of Higher-Dose Universal LDA

Recent Study: UT Southwestern, SMFM 2026

• Design: Pre- and post-implementation cohort comparison
• Cohorts: Before vs. after August 2022, when universal 162mg LDA given to all pregnant women before 16 weeks at Parkland Hospital
• Intervention: Direct dispensing of 162mg LDA to all, continued until ~36 weeks
• Outcomes compared: Rates of severe preeclampsia, postpartum hemorrhage, neonatal bleeding, gastroschisis

Key Findings:

• 29% lower rate of developing severe preeclampsia in the universal 162mg LDA group

  “Universal 162 dose, that cohort compared to the earlier cohort had a 29%—stop there, that’s pretty high—29% lower rate of developing severe preeclampsia compared with the group who had not received aspirin in this form.”
  — Dr. Chapa [19:18]

• Patients who did develop severe preeclampsia with aspirin did so later in pregnancy (closer to term), which is considered beneficial
• Chronic hypertension: Those with chronic hypertension given aspirin were less likely to develop preeclampsia with severe features
• No increase in maternal hemorrhage or placental abruption

  “There was no increase in maternal hemorrhage or placental abruption with aspirin therapy.”
  — Dr. Chapa [20:56]

• Unexpected finding: Slight decrease in postpartum hemorrhage rates (>1000ml blood loss): 8.9% (aspirin) vs. 9.5% (control)

  “There was a decrease in the rate of postpartum hemorrhage, defined as a blood loss greater than 1000mls with aspirin at 8.9 versus 9.5%.”
  — Dr. Chapa [21:28]

• No increase in neonatal intraventricular hemorrhage or gastroschisis

3. Considerations on Bleeding Risk and Dose Response

Dose Safety:

• Previous concerns about bleeding (placental abruption, postpartum hemorrhage) at higher aspirin doses have not been clinically substantiated

• Recent meta-analyses and systematic reviews (e.g., USPSTF, Cochrane) found no increased risk of placental abruption, fetal bleeding, or postpartum hemorrhage between 81mg and 150mg doses ([16:50])

• "Most agree that anything under traditionally 300mg, it's all kind of a low risk. But there is a dose response for preeclampsia prevention and risk reduction." (Dr. Chapa [17:59])

International Comparison:

• UK standard: 150mg LDA (two 75mg tabs)
• US: No 75mg tab, so two 81mg tabs (totaling 162mg) is a practical substitute

4. Impact on Clinical Practice and Guidelines

• The evidence is “moving the needle” toward considering universal use and a slightly higher prophylactic dose in the US
• While guidelines still recommend risk-based 81mg, Dr. Chapa notes these may soon change

“Medicine is done by questioning and adapting and changing. So 81 milligrams: nothing wrong with that. There is benefit...But since there is a dose response...it is reasonable to offer 162 milligrams universally without fear of postpartum hemorrhage, intraventricular neonatal hemorrhage, or even gastroschisis.”
— Dr. Chapa [23:13]

• Decision ultimately up to provider and patient: current guidelines support risk stratification, but emerging data supports universal, higher dosing

5. Memorable Quotes & Moments

• On clinical flexibility:

  “You do what you want to do. I’m not mad at you. I like universal dosing. I believe there’s some benefit over 100 milligrams. That is the best evidence that we have.”
  — Dr. Chapa [09:18]

• On practice evolution:

  “Things are changing, and opinions are changing... The point is, medicine is done by questioning and adapting and changing.”
  — Dr. Chapa [23:13]

• On study design respect:

  “Great work. There’s so many patients that go through the UT Southwestern Parkland system that it’s a great database.”
  — Dr. Chapa [18:29]

Important Timestamps

| Time | Segment Summary | |---------|------------------------------------------------------------------------| | 05:30 | Introduction to aspirin in pregnancy: controversies over dose and recipients | | 09:18 | Dr. Chapa’s stance & practice flexibility on aspirin dosing | | 13:45 | Review of international and latest published data on LDA efficacy | | 16:50 | No safety difference between 81mg vs. 150mg per recent reviews | | 18:29 | Description of UT Southwestern study design and population | | 19:18 | Key outcome: 29% reduction in severe preeclampsia | | 20:56 | No increase in hemorrhage or abruption with aspirin | | 21:28 | Postpartum hemorrhage rates slightly decreased in aspirin group | | 22:12 | No increase in neonatal bleeding/gastroschisis | | 23:13 | Summary: clinical implications and evolving practice |

Tone and Style

• Informative but informal; Dr. Chapa offers evidence-based pearls with humor and warmth (“Are you all wearing hats? That was weird.” [20:40])
• Encourages adaptability, open-mindedness, and individualized clinical judgment

Clinical Takeaways

• Universal 162mg aspirin in pregnancy is supported by new major data (UT Southwestern, SMFM 2026) for reducing severe preeclampsia—with no increase (and possibly a decrease) in major bleeding risks or neonatal complications
• Both 81mg and higher doses are supported by guidelines; higher doses may provide greater benefit
• Providers should watch for forthcoming updates in guidelines and discuss evolving evidence with patients

“Congratulations to Elaine and her team from UT Southwestern. Phenomenal... Proud roots at UT Southwestern and Parkland Hospital.”
— Dr. Chapa [23:56]

For more evidence-based, practical clinical updates in women’s health, keep following Dr. Chapa’s OBGYN Clinical Pearls.