Aspirin and pregnancy: A comprehensive review

Aspirin (acetylsalicylic acid) is a widely used nonsteroidal anti-inflammatory drug (NSAID) with increasing application in obstetrics, and most importantly, for the prevention of placental-mediated complications. The aim of this review is to discuss the use of low-dose aspirin (LDA) in pregnancy, focusing on its advantages of reducing the occurrence of preeclampsia and fetal growth restriction (FGR). Its mechanism involves the irreversible inhibition of cyclooxygenase (COX) enzymes, thus enhancing uteroplacental blood flow and reducing placental ischemia. Clinical trials, such as the ASPRE trial, demonstrated that aspirin, initiated before 16 weeks of gestation, significantly lowers the risk of preterm preeclampsia. Aspirin has also been found to be beneficial in antiphospholipid syndrome (APS), recurrent pregnancy loss, and preterm birth prevention. Despite its benefits, there are still challenges in optimizing patient selection, dosing, and guideline compliance. Future research must address individualized medical strategies, long-term neonatal outcomes, and access to care in low-resource environments. This review documents the changing role of aspirin in the management of pregnancy and reinforces the call for ongoing research to maximize its clinical application.