Prevention of perinatal death and adverse perinatal outcome using low-dose aspirin: a meta-analysis
ABSTRACT:
Objectives:
To compare early-onset vs. late-onset administration of low-dose aspirin (LDA) on the risk of perinatal death and adverse perinatal outcomes.
Study design:
Databases were search for key words related to aspirin and pregnancy. Only randomized controlled trials that evaluated the prophylactic use of LDA (50 to 150 mg/day) during pregnancy were included. The primary outcome combined fetal and neonatal death. Pooled relative risks (RR) with their 95% confidence intervals (CI) were compared according to gestational age at initiation of LDA (≤16 vs. >16 weeks of gestation).
Results:
Out of 8,377 citations, 42 studies (27,222 women) were included. Inclusion criteria were risk factors for preeclampsia including: nulliparity, multiple pregnancy, chronic hypertension, cardiovascular or endocrine disease, prior gestational hypertension or fetal growth restriction, and/or abnormal uterine artery Doppler. When compared to controls, LDA started ≤16 weeks’ gestation was associated with a greater reduction of perinatal death (RR: 0.41, 95% CI: 0.19-0.92 vs. >16 weeks: RR: 0.93, 95% CI: 0.73-1.19; p=0.02); preeclampsia (0.47, 95% CI: 0.36, 0.62 vs RR: 0.78, 95% CI: 0.61, 0.99; p<0.01); severe preeclampsia (0.18, 95% CI: 0.08, 0.41 vs RR: 0.65, 95% CI: 0.40, 1.07; p<0.01); fetal growth restriction (0.52, 95% CI: 0.32, 0.87 vs RR: 0.98, 95% CI: 0.88, 1.08; p<0.01); and preterm birth (0.35, 95% CI: 0.22, 0.57 vs RR: 0.90, 95% CI: 0.83, 0.97; p<0.01) than LDA started >16 weeks.
Conclusion:
LDA initiated ≤16 weeks of gestation is associated with a greater reduction of perinatal death and other adverse perinatal outcomes than when initiated >16 weeks.
Reference:
http://onlinelibrary.wiley.com/doi/10.1002/uog.12421/abstract;jsessionid=C9BAFBE1806C8059C63C3A99541D6EED.d01t04
