Bridging the gap: Exploring aspirin prophylaxis for preeclampsia prevention in pregnant women with endometriosis

Preeclampsia (PE) represents a significant contributor to maternal and fetal morbidity and mortality, affecting approximately 2%–8% of pregnancies worldwide. While aspirin prophylaxis has demonstrated efficacy in reducing the risk of PE among high-risk populations, current clinical guidelines do not recognize endometriosis as a risk factor warranting aspirin prophylaxis. Endometriosis, a chronic inflammatory condition affecting approximately 10% of women of reproductive age, has been associated with a heightened risk of hypertensive disorders in pregnancy, including PE. This narrative review investigates the relationship between endometriosis and PE, focusing on shared pathophysiological mechanisms such as systemic inflammation, immune dysregulation, and impaired vascular remodeling. These mechanisms not only underpin the increased risk of PE in women with endometriosis but may also be mitigated through aspirin therapy. This review aims to evaluate the potential protective effect of aspirin in reducing preeclampsia risk in this population, identify gaps and limitations in the existing literature, and justify the need for further research on this association. Furthermore, barriers to the implementation of aspirin prophylaxis in this population will be addressed, alongside recommendations for studies aimed at bridging these gaps to enhance maternal and fetal health outcomes.