Low-dose Aspirin Delays the Onset of Pre-eclampsia in an Unselected Population of Ivf/icsi Pregnancies by Almost 4 Weeks

Background Pre-eclampsia, a leading cause of maternal and perinatal mortality, presents with increased frequency and severity in pregnancies conceived via assisted reproductive technology (ART). The distinction between early-onset (< 34 weeks) and late-onset (≥ 34 weeks) pre-eclampsia is life-threatening, as the former is associated with substantially greater morbidity. While low-dose aspirin (LDA) is recommended for prevention in high-risk groups, its specific impact on the timing of disease onset in in-vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) pregnancies, particularly in regions like sub-Saharan Africa, remains insufficiently characterised. The study aimed to compare the gestational age at onset of pre-eclampsia between IVF/ICSI pregnancies with and without LDA prophylaxis in Kumasi, Ghana. Methods A prospective cohort study was conducted at four specialist ART centres in Kumasi from August 2024 to February 2025. One hundred women with ongoing singleton or multiple pregnancies conceived via IVF/ICSI were recruited at or beyond 20 weeks of gestation and followed until delivery. Participants were allocated into two groups of 50, based on their use of LDA: an exposed group that received aspirin and a non-exposed (control) group. The primary outcome was the gestational age at diagnosis of pre-eclampsia, defined according to the 2021 International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria. Results The use of LDA was associated with a profound shift in the clinical presentation of pre-eclampsia. The mean gestational age at diagnosis was significantly later in the aspirin group (36w + 5d) compared to the non-aspirin group (32w + 6d), representing a delay of nearly four weeks. Most outstandingly, there was a complete absence of early-onset pre-eclampsia in the aspirin group (0%), whereas 47.1% of pre-eclampsia cases in the non-aspirin group occurred before 34 weeks of gestation. This indicates that aspirin not only delayed the onset of the disease but also effectively prevented its most severe, early-gestation phenotype in this cohort. Conclusion Low-dose aspirin prophylaxis in IVF/ICSI pregnancies results in a clinically meaningful delay in the onset of pre-eclampsia. Its primary benefit appears to be the prevention of the more dangerous early-onset form of the disease, thereby modifying its clinical course towards a more manageable, near-term presentation. These findings underscore the critical importance of implementing routine LDA prophylaxis in this high-risk obstetric population to improve maternal and perinatal outcomes.