ASPIRIN FOR PRE-ECLAMPSIA PREVENTION: A SYSTEMATIC REVIEW OF DOSE AND TIMING EFFECTIVENESS

Background: Preeclampsia is a hypertensive disorder of pregnancy affecting approximately 4% of pregnancies, contributing significantly to maternal and perinatal morbidity . Low-dose aspirin is widely recommended for preeclampsia prevention in high-risk pregnancies, but the optimal dose and timing of initiation remain under debate. This review evaluates different aspirin dosages (e.g., 75–81 mg vs 100–150 mg) and timing (initiation before vs after 16 weeks' gestation) for prevention of preeclampsia. Methods: We performed a systematic review of clinical studies following PRISMA guidelines.A comprehensive search of PubMed,Embase,and Cochrane Library (through April 2025) identified randomized controlled trials (RCTs) and observational studies examining aspirin prophylaxis in pregnancy and reporting preeclampsia outcomes. Data on study characteristics, aspirin dose, gestational age at initiation, and clinical outcomes were extracted. Quality was assessed using the Cochrane risk-of-bias tool for RCTs and Newcastle–Ottawa scale for observational studies. Outcomes of interest included incidence of preeclampsia (overall, preterm <37 weeks, and severe), as well as maternal and fetal outcomes. Results: A total of 38 studies (33 RCTs and 5 observational; >40,000 pregnancies) met inclusion criteria. Low-dose aspirin significantly reduced the risk of preeclampsia in high-risk pregnant women compared to placebo . Aspirin initiated before 16 weeks' gestation was associated with greater efficacy than later initiation,with a relative risk reduction up to ~50% when started early .Higher aspirin dosages (≈100–150 mg daily) conferred greater reduction in preeclampsia, especially preterm preeclampsia, compared to traditional 75–81 mg doses . For example, in women at high risk, aspirin 150 mg nightly from the first trimester reduced preterm preeclampsia by ~62% ,whereas trials using 60–81 mg showed only modest (10–20%) risk reductions or no significant benefit .No significant increase in maternal bleeding complications was observed with lowdose aspirin use ,even at the higher doses (e.g.150 mg) .Tables 1 and 2 summarize key RCT and observational findings. Conclusions: Prophylactic low-dose aspirin is an effective strategy to prevent preeclampsia,particularly when given at adequate doses (≥100 mg daily) and started before 16 weeks' gestation in women at elevated risk.Early aspirin initiation was consistently associated with reductions in preterm and severe preeclampsia.Both 75–81 mg and 150 mg regimens appear safe in pregnancy, with emerging evidence favoring the higher dose for maximal efficacy. Clinicians should initiate low-dose aspirin by the late first trimester in high-risk pregnancies,with dose selection individualized based on patient risk factors and regional guidelines. Further large RCTs comparing aspirin dosages are needed, but current evidence supports integrating early low-dose aspirin (often 150 mg) into prenatal care to reduce the burden of preeclampsia.

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