In Chinese women with chronic hypertension (CHT, n=504 singleton pregnancies, 8–20 weeks gestation, 2013–2025), this retrospective cohort study compared aspirin prophylaxis (n=307) vs. no aspirin (n=197) on rates of superimposed preeclampsia and adverse maternal/perinatal outcomes.
Aspirin use was associated with markedly lower odds of superimposed preeclampsia (aOR 0.183, 95% CI 0.119–0.280), early-onset preeclampsia <34 weeks (aOR 0.092, 95% CI 0.050–0.168), and preterm preeclampsia <37 weeks (aOR 0.142, 95% CI 0.087–0.231); it also reduced preterm birth, placental abruption, SGA, neonatal asphyxia, NICU admission, stillbirth, and perinatal death, with no increase in cesarean delivery or postpartum hemorrhage.
Retrospective design limits causal inference and may introduce selection bias in who received aspirin; the study is limited to Chinese women at two tertiary centers, restricting generalizability; aspirin dose-response findings are exploratory and require prospective validation.
Clinicians managing pregnant women with chronic hypertension should consider early-to-mid pregnancy aspirin prophylaxis, as it is associated with substantial reductions in superimposed preeclampsia and serious perinatal complications without apparent bleeding risk.
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