Why is Aspirin used to manage preeclampsia?

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Pre-eclampsia is defined as hypertension arising after 20 weeks of gestational age with proteinuria or other signs of end-organ damage and is an important cause of maternal and perinatal morbidity and mortality, particularly when of early onset.

Aspirin at doses below 300 mg selectively and irreversibly inactivates the cyclooxygenase-1 enzyme, suppressing the production of prostaglandins and thromboxane and inhibiting inflammation and platelet aggregation. The effect of Aspirin is more pronounced in women with good compliance to treatment. In general, randomized trials are underpowered to investigate the treatment effect of Aspirin on the rates of other placental-associated adverse outcomes, such as fetal growth restriction and stillbirth.

The secondary analysis of the Aspirin for Evidence-Based Pre-eclampsia Prevention Trial data also indicated a 68 percent reduction in the length of stay in the neonatal intensive care unit compared with the placebo, primarily due to a decrease in births before 32 weeks of gestational age with pre-eclampsia.

Evidence-based pre-eclampsia prevention trials have revealed that Aspirin, at a daily dosage of 150 mg, initiated before 16 weeks of gestational age and given at night to a high-risk population identified by a combined first-trimester screening test, reduces the incidence of preterm pre-eclampsia by 62 percent.

Low-dose Aspirin (81 mg/day) prophylaxis is recommended in women at high risk of pre-eclampsia and should be initiated between 12 weeks and 28 weeks of gestation (optimally before 16 weeks) and continued daily until delivery.

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