MERYM MOHAMMED ALHAKIM, MAYSOON MOHAMED ABDELWAHAB MAHGOUB, SHAZA AHMED AWAD AHMED, DINA AHMED ABDELATTY ABDELRAHMAN, BAYAN MOHAMMED OTHMAN ALTURKI, FATIN MOHAMED AHMED BADRI, MAAB ABDUSALAM EMAM ,RYAN OSMAN ALHESSEN SAIDAHMED, QUSAI RAED GAZZAZ, GAMEELA DIYAB IBRAHIM ABDALLA, HIND MUSTAFA MOHAMED AWOODAH, EMAN OSMAN OMER ABDALLAH, SAFIA MAMOUN YOUSIF, SARAH KHALEED ALTOWAIRQI, SARAH NABEEL OMAR AKEEL
DOI: https://doi.org/Background: Preeclampsia remains one of the leading causes of maternal and neonatal morbidity and mortality worldwide. Low-dose aspirin (LDA) has been proposed as a preventive intervention, particularly for women at high risk.
Objective: This systematic review aimed to evaluate and compare the impact of LDA on the incidence of preeclampsia, gestational hypertension, and adverse perinatal outcomes in high-risk pregnancies.
Methods: A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library databases from 2000 to 2025. Ten randomized controlled trials and meta-analyses that met inclusion criteria were analyzed. Studies assessed LDA dosages (50–160 mg/day), initiation timing (≤16 weeks), and outcomes related to preeclampsia prevention.
Results: Most studies demonstrated significant reductions in the incidence of preterm and severe preeclampsia with early initiation of LDA, particularly when doses ≥100 mg/day were administered. Notably, the ASPRE and PREDO trials confirmed a 60–70% reduction in preterm preeclampsia. Trials that initiated LDA later or included unselected populations showed limited benefit. Safety analyses across all studies confirmed that LDA does not increase the risk of hemorrhagic or fetal complications.
Conclusion: Early administration of low-dose aspirin in high-risk pregnancies significantly reduces the risk of preeclampsia and associated complications without adverse safety effects. The preventive efficacy is enhanced by early initiation (<16 weeks) and adherence to doses ≥100 mg/day.
