The Impact of Low-Dose Aspirin on Reducing the Risk of Preeclampsia in High-Risk Pregnant Women: A Comparative Analytical Review

Abstract

Atef Eid Madkour Elsayed*, Yasmeen Noorulfislam Abualhussafin Albarzan, Wed Alkihder Ahmed Alsaggaf, Amir Faisal Alenaze, Asrar Fawaz Alanazi5,Hania Mohammed Saeed, Abdullah A Ali, Zainab Siddig Gebril Ali, Batool Ahmed Alsubaiti, Egbal Lutfi Mohamed Salih

Background: Preeclampsia (PE) remains a leading cause of maternal and neonatal morbidity worldwide. Lowdose aspirin (LDA) has been increasingly adopted for its potential role in preventing PE, particularly in high-risk pregnancies. This review evaluates current evidence on its effectiveness, optimal timing, dosage, and associated clinical considerations.

Objective: To critically analyze and synthesize peer-reviewed literature on the use of low-dose aspirin to prevent preeclampsia in high-risk pregnant populations and identify factors influencing its efficacy and safety.

Methods: A systematic review was conducted following PRISMA 2020 guidelines. Studies published between 1998 and 2025 were identified through PubMed, Scopus, Web of Science, Embase, and Google Scholar using predefined search terms. Eligible studies included RCTs, cohort studies, and systematic reviews focusing on LDA prophylaxis in high-risk pregnancies.

Results: Twenty-seven studies were included. Evidence consistently supports aspirin use-particularly when initiated before 16 weeks gestation—for reducing the incidence of PE. Dosages between 75-162 mg were effective, though higher doses showed greater benefits in select populations. Safety was largely confirmed, but some concerns were noted regarding fetal renal development and postpartum haemorrhage. Provider knowledge and adherence influenced effectiveness in low-resource settings.

Conclusion: Low-dose aspirin significantly reduces the risk of preeclampsia when initiated early and appropriately dosed. Personalized prophylactic strategies, grounded in patient risk profiles and healthcare system capacity, are essential to maximize its benefits while minimizing adverse outcomes.