Introduction: Hypertensive disorders of pregnancy (HDPs), including preeclampsia, disproportionately contribute to preventable maternal morbidity and mortality. This study examined variations in clinician counseling and management of HDPs, provider communication about low-dose aspirin (LDA) prophylaxis, and barriers and facilitators to patient activation.

Methods: A cross-sectional, mixed-methods study was conducted with perinatal care providers at two Midwest academic medical centers (2021–2022). An online survey was completed by 74 providers, followed by semi-structured interviews with a purposive sample of 13 providers. Survey data were analyzed descriptively using SAS 9.4; interview transcripts were analyzed using deductive thematic analysis with intercoder reliability.

Results: All interviewed providers recommended LDA initiation between 12- and 16-weeks’ gestation. Primary barriers included limited medication adherence (43%) and appointment non-attendance (16.5%). Facilitators included LDA’s low cost, over-the-counter availability, and established safety profile. Themes include initiating conversations about LDA with all patients regardless of risk, emphasizing universal LDA uptake, and recognizing continued preeclampsia risk postpartum.

Conclusions: Providers demonstrated familiarity with HDP guidelines but exhibited inconsistencies in counseling. Reframing “patient compliance” as “patient activation” supports equity-centered shared decision-making. Recommended strategies include establishing universal LDA recommendation protocols, expanding Medicaid coverage to reduce insurance barriers, and implementing community-focused public health education initiatives.