A study of comparison between efficacy of low-dose aspirin and high-dose aspirin in highrisk pregnancies according to Gestosis score

Background: Preeclampsia remains a major cause of maternal and perinatal morbidity, particularly in high-risk pregnancies. Although aspirin is widely recommended for prevention, the optimal prophylactic dose remains uncertain. This study compared maternal, fetal, and neonatal outcomes with 75 mg and 150 mg aspirin among high risk pregnant women identified using the Gestosis score. Aim and Objectives: This study aimed to compare maternal, fetal, and neonatal outcomes of aspirin 75 mg versus 150 mg in high-risk pregnancies. Materials and Methods: This prospective randomized controlled trial included 100 high-risk pregnant women with a Gestosis score ≥3 at Mahatma Gandhi Memorial Government Hospital, Tiruchirappalli. Participants received either 75 mg (n=50) or 150 mg (n=50) aspirin daily, initiated between 11 and 16 weeks and continued until 36 weeks of gestation. Maternal, fetal, neonatal, and treatment-related outcomes were compared between groups. Results: Gestational hypertension (50% vs. 24%; P<0.01) and preeclampsia (44% vs. 14%; P=0.002) were significantly lower with 150 mg aspirin. Preeclampsia increased significantly with higher Gestosis scores (P=0.002). The 150 mg group had lower rates of fetal growth restriction (10% vs. 28%; P=0.041) and preterm birth (14% vs. 32%; P=0.032), with higher birth weight (2516.64±344.64 vs. 2341.50±401.22 g; P=0.021). Neonatal intensive care unit admission and perinatal mortality did not differ significantly. Gastrointestinal adverse effects were more frequent with 150 mg (14% vs. 0%; P=0.012), whereas bleeding episodes were comparable. Conclusion: Aspirin 150 mg was associated with lower rates of preeclampsia and selected adverse fetomaternal outcomes than 75 mg, without increased bleeding complications. Higher Gestosis scores were associated with greater preeclampsia occurrence, supporting their role in risk stratification.