Preeclampsia remains one of pregnancy's most dangerous complications, affecting millions globally and driving maternal mortality rates that have barely improved in decades. Understanding which interventions actually prevent this hypertensive disorder could fundamentally alter prenatal care protocols and save countless lives. The convergence of multiple landmark clinical trials has now established a clearer roadmap for both prevention and management of this complex condition. Low-dose aspirin has emerged as the cornerstone preventive therapy, with robust evidence demonstrating its ability to reduce preeclampsia risk when initiated early in pregnancy. This finding represents decades of research validating the inflammatory and vascular dysfunction pathways underlying the condition. Equally significant, recent trials have shown that treating even mild chronic hypertension during pregnancy reduces preeclampsia incidence and associated complications, challenging previous assumptions about intervention thresholds. Statin medications, traditionally avoided in pregnancy, are showing unexpected promise as preventive agents, though this application remains investigational. The research has also refined critical management protocols, particularly around magnesium sulfate for seizure prevention and optimal delivery timing decisions. These advances reflect a more sophisticated understanding of preeclampsia as a multi-system disorder rather than simply elevated blood pressure. However, significant gaps persist in identifying novel therapeutic targets and personalizing prevention strategies. The condition's heterogeneous nature means that one-size-fits-all approaches may miss important subgroups of high-risk patients. While these trial results offer genuine hope for reducing preeclampsia's devastating impact, translating findings into widespread clinical practice remains challenging, particularly in resource-limited settings where maternal mortality from hypertensive disorders remains highest.