LOW-DOSE aspirin could reduce the risk of pre-eclampsia and preterm birth among women who conceive through assisted reproductive technology (ART), according to new research.
The prospective cohort study found substantially lower rates of pre-eclampsia among women taking aspirin following IVF or intracytoplasmic sperm injection (ICSI), highlighting a potential gap in preventive care for this high-risk population.
Researchers followed 100 women with ongoing IVF or ICSI pregnancies across four private ART centres in Kumasi, Ghana. Of these, 50 had started low-dose aspirin during the first trimester, while 50 were not receiving aspirin prophylaxis.
The study population was already at high risk of pre-eclampsia. Participants had a mean age of approximately 41 years, more than half had obesity, 74% were nulliparous, and 55% had multifetal pregnancies. Additionally, 72% had conceived using donor oocytes.
Despite this high-risk profile, pre-eclampsia occurred in 10% of women taking aspirin compared with 34% of those not taking aspirin, representing an approximately 71% relative reduction in risk. Based on this difference, the researchers estimated that around four women would need to receive aspirin for one fewer case of pre-eclampsia to occur compared with no aspirin.
As the study was observational rather than randomised, however, the findings demonstrate an association and do not establish that aspirin directly caused the reduction in pre-eclampsia.
Among women who developed pre-eclampsia, diagnosis occurred at an average of 36.5 weeks among aspirin users compared with 32.6 weeks among non-users, although this difference was not statistically significant.
Notably, no aspirin users developed early-onset pre-eclampsia before 34 weeks, compared with six cases among women not receiving aspirin. Two pregnancies in the non-aspirin group were also terminated before 28 weeks because of severe pre-eclampsia.
Aspirin use was also associated with fewer preterm deliveries, which occurred in 30% of aspirin users compared with 56% of non-users. Women taking aspirin additionally had higher 5-minute Apgar scores – which evaluates a newborn’s heart rate, breathing, muscle tone, reflexes, and colour – and shorter maternal hospital stays.
Despite these findings, aspirin prophylaxis was uncommon. Of 243 eligible IVF/ICSI pregnancies identified across the four centres, only 55 women (22.6%) were receiving low-dose aspirin, while 77.4% were not.
The researchers suggest that this represents an important gap between evidence and clinical practice, particularly because many women had additional recognised risk factors for pre-eclampsia.
However, the authors emphasised that the study was small and observational. Women were not randomly assigned to receive aspirin, and the sample size was insufficient for multivariable adjustment, meaning unmeasured differences between the groups could have influenced the results.
Larger randomised studies are therefore needed to determine the effectiveness and optimal dose of aspirin specifically in ART pregnancies. Nevertheless, the findings highlight the potential importance of early pre-eclampsia risk assessment and appropriate preventive care among women undergoing IVF and ICSI.
Reference
Agana E A. et al. Aspirin use for pre-eclampsia prevention in IVF/ICSI pregnancies in Kumasi, Ghana: a prospective cohort study. Reproductive Health. 2026. doi:10.1186/s12978-026-02423-9.
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