Low-Dose Aspirin for the Prevention of Preeclampsia: A Systematic Review and Meta-analysis

Abstract

Introduction: Preeclampsia continues to be a major cause of maternal and neonatal morbidity and mortality globally, and is defined by hypertension and multiple-system dysfunction following the 20th week of gestation. The burden of preeclampsia is exacerbated by regional risk factors in Saudi Arabia, including obesity, pre-gestational diabetes and advanced maternal age. Low-dose aspirin (LDA) is a very important prophylactic intervention because it shifts the balance of thromboxane and prostacyclin and enhances placental perfusion. There are, however, some differences in the Kingdom with regard to dosage and time of initiation. Objective: The objective of this systematic review and meta-analysis was to assess the effectiveness and safety of low dose aspirin (75-150mg) in preventing preeclampsia and poor neonatal outcome in high risk pregnant women, particularly in the context of the Saudi health care system. Methods: A systematic literature search was performed in PubMed, Scopus, Web of Science and the Cochrane Library databases for randomized controlled trials (RCTs) and high-quality observational studies up to the beginning of 2026. Data extraction and quality assessment were carried out separately from the other researchers, following the PRISMA 2020 guidelines. The pooled Risk Ratios (RR) and 95%. Conclusion: This meta-analysis demonstrates that daily LDA is effective at decreasing the incidence of preeclampsia, which was diagnosed as preterm. Sub-group analysis showed that therapy started before 16 weeks of gestation and doses of 100 mg (usually 150 mg) had the largest protective effect. Additionally, LDA was correlated with a significant decrease in IUGR and NICU admissions. The included studies indicated no statistically significant difference in any maternal complications, including postpartum hemorrhage.