From empirical regimens to precision prophylaxis: mechanism-based targeting of preeclampsia phenotypes

Currently, prevention strategies for preeclampsia are mainly based on standard low-dose aspirin. However, the clinical efficacy of this regimen exhibits significant heterogeneity across diverse patient populations. This review proposes that future prevention strategies should shift from empirical uniform regimens to individualized precision interventions based on molecular endotypes. Latest evidence indicates that for multiple pregnancies, high-dose aspirin (≥150 mg/d) may be required to neutralize the supraphysiological load of placenta-derived extracellular vesicles. In pregnant women with chronic hypertension, the combination of low-dose aspirin and low molecular weight heparin exert synergistic protection of endothelial glycocalyx integrity, achieving dual benefits of antithrombosis and endothelial protection. For metabolic high-risk populations, statins demonstrate superior therapeutic potential compared to metformin in restoring angiogenic balance by activating the heme oxygenase 1/carbon monoxide pathway and inhibiting the adipokine chemerin. In conclusion, future strategies for preeclampsia prevention should transcend traditional clinical risk stratification to establish mechanism-based precision therapies. This paradigm shift aims to achieve individualized interventions that are matched to the specific molecular endotypes driving disease pathogenesis.