Aspirin for Prevention of Preeclampsia

Abstract

Aspirin is currently the most widely prescribed treatment in the prevention of cardiovascular complications. The indications for the use of aspirin during pregnancy are, however, the subject of much controversy. Since the first evidence of the obstetric efficacy of aspirin in 1985, numerous studies have tried to determine the effect of low-dose aspirin on the incidence of preeclampsia, with very controversial results. Large meta-analyses including individual patient data have demonstrated that aspirin is effective in preventing preeclampsia in high-risk patients, mainly those with a history of preeclampsia. However, guidelines regarding the usage of aspirin to prevent preeclampsia differ considerably from one country to another. Screening modalities, target population, and aspirin dosage are still a matter of debate. In this review, we report the pharmacodynamics of aspirin, its main effects according to dosage and gestational age, and the evidence-based indications for primary and secondary prevention of preeclampsia.

Fig. 1

Biosynthesis of eicosanoids. PGH2 prostaglandin H2, PGHE2 prostaglandin E2, PGHD2 prostaglandin D2, PGF2α prostaglandin F2 alpha, PGI2 prostaglandin I2, TXA2 thromboxane A2

Fig. 2

Hydrolysis of aspirin and conjugation of salicylic acid

Fig. 3

Mode of action of aspirin. Ser serine, COX cyclooxygenase, PGH2 prostaglandin H2, AA arachidonic acid