High-dose Aspirin is more effective than Low-dose Aspirin for Prevention of Preeclampsia in High-risk Pregnant Women: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Abstract Body (Do not enter title and authors here): Introduction: Preeclampsia is a multisystem progressive disease of pregnancy, characterized by a new onset of hypertension (≥ 140/90 mm Hg) with proteinuria after the 20th week of gestation. There is a conflict between United States guidelines that recommend Low-dose aspirin (LDA) and United Kingdom guidelines that recommend High-dose aspirin (HDA) for the prevention of preeclampsia in high-risk pregnant women. After the latest study that recommends HDA and the absence of pairwise meta-analyses comparing two doses, we aimed to conduct a comprehensive pairwise meta-analysis to assess whether HDA is better than LDA in the prevention of preeclampsia.
Methods: We conducted a systematic search on PubMed, Scopus, Cochrane Central, and Web of Science (WOS) from inception until June 2025. All randomized controlled trials (RCTs) comparing LDA and HDA in high-risk pregnant women were included. Our primary outcome was the incidence of preeclampsia (PE), while secondary outcomes were Placental abruption, Pre-term delivery, and Intrauterine Growth Restriction (IUGR). Using random-effects models, we calculated risk ratios (RR) with 95% confidence intervals (CIs).
Results: A total of 8 RCTs with 1,290 patients from the United States, Canada, England, and different Asian countries were included, among whom 642 (49.8%) patients were randomized to HDA. All studies compared HDA (≥ 150 mg) and LDA (75 mg to 81 mg). Patients with LDA had a higher risk of Preeclampsia (RR: 1.71, 95% CI: 1.19 to 2.44, p<0.001) compared to HDA. There was no significant difference between the LDA and HDA regarding Placental abruption, Pre-term delivery, and IUGR. With a pooled RR with a 95% CI (1.8, [0.91 to 3.54], P = 0.09), (1.25, [0.79 to 1.97], P = 0.34), (1.5, [0.93 to 2.42], P = 0.1), respectively.
Conclusion: Among high-risk pregnant women, LDA was associated with a 71% higher incidence of preeclampsia than HDA. These results support the use of HDA as a preventive medication for preeclampsia in high-risk pregnant women.
Hassanin, Mohammed Sabri
( Faculty of Medicine, Al-Azhar University
, Cairo
, Egypt
)
Alsulaiman, Sultan Bander
( College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU)
, Riyadh
, Saudi Arabia
)
Alotaibi, Fahad Mohsin
( College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU)
, Riyadh
, Saudi Arabia
)
Gado, Mazen Ibrahem
( Faculty of Medicine, Mansoura University
, Mansoura
, Egypt
)
Balbaa, Elsayed
( Faculty of Medicine, Alexandria University
, Alexandria
, Egypt
)
Sobhy, Ahmed
( Faculty of Medicine, Kafr Elshiekh University
, Kafr Elshiekh
, Egypt
)
Hafez, Abdelrahman
( Cardiology Department, Mayo Clinic
, Phoenix
, Arizona
, United States
)
Qenawy, Abdulrahman
( Faculty of Medicine, South Valley University
, Qena
, Egypt
)
Kasem, Ahmed Wahdan
( Faculty of Medicine, Al-Azhar University
, Cairo
, Egypt
)
Awadalla, Yasein F.
( Faculty of Science, Al-Azhar University
, Cairo
, Egypt
)
Aljanadi, Raghad
( Faculty of Medicine, Al-Azhar University
, Cairo
, Egypt
)
Awad, Rawan Mohammed
( Collage of Pharmacy, King Saud University (KSU)
, Riyadh
, Saudi Arabia
)
Awad, Mohammed Yousef
( Faculty of Medicine, Mansoura University
, Mansoura
, Egypt
)
Ghonim, Abdullah Nasser
( Faculty of Medicine, Al-Azhar University
, Cairo
, Egypt
)
Hussein, Mahmoud
( Faculty of Medicine, Al-Azhar University
, Cairo
, Egypt
)
Author Disclosures:
Mohammed Sabri Hassanin:DO NOT have relevant financial relationships
| Sultan Bander AlSulaiman:DO NOT have relevant financial relationships
| Fahad Mohsin Alotaibi:No Answer
| Mazen Ibrahem Gado:No Answer
| Elsayed Balbaa:DO NOT have relevant financial relationships
| Ahmed Sobhy:DO NOT have relevant financial relationships
| Abdelrahman Hafez:DO NOT have relevant financial relationships
| Abdulrahman Qenawy:No Answer
| Ahmed Wahdan Kasem:DO NOT have relevant financial relationships
| Yasein F. Awadalla:No Answer
| Raghad Aljanadi:No Answer
| Rawan Mohammed Awad:No Answer
| Mohammed Yousef Awad:No Answer
| Abdullah Nasser Ghonim:No Answer
| Mahmoud Hussein:No Answer
Jiang Chao, Dong Jianzeng, Cai Jun, Anderson Craig, Du Xin, Tang Yangyang, Han Rong, Song Yanna, Wang Chi, Lin Xiaolei, Yi Yang, Rodgers Anthony, Ma Changsheng
Elbahloul Mohammed A., Al-badri Sajjad Ghanim, Al Sakini Ahmed, Elgendy Islam, Mansour Ahmed, Mohamed Ahmed, Elazab Ahmed, Kasem Ahmed Wahdan, Kurmasha Yousif, Ibrahim Rahma, Al-shammari Ali Saad, Hassanin Mohammed Sabri
