Evidence for acetylsalicylic acid (aspirin) in the prevention of preeclampsia: a narrative review

Abstract

Objective: To describe the methods used to predict preeclampsia and how to prevent it using low-dose acetylsalicylic acid (aspirin) according to the recommendations of the main obstetrics and gynecology organizations. Methodology: We searched PubMed and Cochrane Library from January 1, 2020, to May 1, 2022, using the terms “pre-eclampsia”, “hypertensive disorders in pregnancy” and “hypertension and pregnancy”. We focused on the analyses and recommendations from the most recognized international obstetrics and gynecology organizations, independent of the original language. Results: For the prediction of preeclampsia, two strategies are used that aim to find the population at highest risk based on: 1) clinical findings of risk for pre-pregnancy or pregnancy conditions, and 2) a multi-factor algorithm that includes clinical findings, blood pressure, biomarker and uterine artery Doppler. Using both strategies, variable effectiveness of aspirin in preventing preeclampsia is found. The most effective dose range between 50-150 mg, with 81 mg being the most recommended at present. The dose of 150 mg per day has shown effectiveness in preeclampsia far from term; however, it is considered to have more side effects. Conclusions: The most prestigious and recognized obstetrics and gynecology and health organizations recommend low-dose aspirin to prevent preeclampsia, preferably at the beginning of the second trimester of pregnancy and maintained until 36-37 weeks.