Background: Low-dose aspirin reduces preeclampsia risk, but optimal timing and dosing require refinement. Methods: RCT of 1,640 high-risk pregnancies randomized to aspirin 150mg vs. 100mg vs. placebo initiated at 11-14 weeks. Primary outcome: preterm preeclampsia (<37 weeks). Results: Preterm preeclampsia: aspirin 150mg 2.7% vs. 100mg 3.8% vs. placebo 7.4%. NNT for 150mg vs. placebo: 21. Uterine artery PI-based selection enhanced treatment benefit. Conclusion: Aspirin 150mg initiated in first trimester provides superior preterm preeclampsia prevention, supporting dose optimization in high-risk pregnancies
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