Preeclampsia is associated with significant perinatal morbidity and mortality. Aspirin has been long purported and extensively studied for prevention of preeclampsia. For this reason, the U.S. Preventive Services Task Force, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine recommend its use in pregnancy for preeclampsia prevention in those at high risk. Yet, much controversy exists regarding optimal use in pregnancy with guidelines across global organizations varying. In this narrative review, we summarize the published literature related to the safety, optimal dose, and timing and duration of use of aspirin, as well as other indications for which aspirin has been studied in pregnancy.
In the United States, preeclampsia complicates 2–8% of pregnancies, is responsible for 6% of preterm births, and is a leading cause of maternal death.1 The underlying pathophysiology of preeclampsia may be related to inadequate placental trophoblast invasion and spiral artery remodeling. Aspirin has anti-inflammatory properties hypothesized to improve placentation, thereby preventing preeclampsia.1–3 A growing body of evidence supports this hypothesis, particularly in groups at high risk for preeclampsia.4–6