Prevention of perinatal death and adverse perinatal outcome using low‐dose aspirin: a meta‐analysis

Wiley - Tập 41 Số 5 - Trang 491-499 - 2013
Stéphanie Roberge1, K. H. Nicolaides2, Suzanne Demers3, Pia Villa4, Emmanuel Bujold3,1
1Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, Qc, Canada
2Harris Birthright Research Centre of Fetal Medicine, King's College Hospital, London, UK
3Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec City, Qc, Canada
4Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland

Tóm tắt

ABSTRACTObjectiveTo compare early vs late administration of low‐dose aspirin on the risk of perinatal death and adverse perinatal outcome.MethodsDatabases were searched for keywords related to aspirin and pregnancy. Only randomized controlled trials that evaluated the prophylactic use of low‐dose aspirin (50–150 mg/day) during pregnancy were included. The primary outcome combined fetal and neonatal death. Pooled relative risks (RR) with their 95% CIs were compared according to gestational age at initiation of low‐dose aspirin (≤ 16 vs > 16 weeks of gestation).ResultsOut of 8377 citations, 42 studies (27 222 women) were included. Inclusion criteria were risk factors for pre‐eclampsia, 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 with controls, low‐dose aspirin started at ≤ 16 weeks' gestation compared with low‐dose aspirin started at >16 weeks' gestation was associated with a greater reduction of perinatal death (RR = 0.41 (95% CI, 0.19–0.92) vs 0.93 (95% CI, 0.73–1.19), P = 0.02), pre‐eclampsia (RR = 0.47 (95% CI, 0.36–0.62) vs 0.78 (95% CI, 0.61–0.99), P < 0.01), severe pre‐eclampsia (RR = 0.18 (95% CI, 0.08–0.41) vs 0.65 (95% CI, 0.40–1.07), P < 0.01), fetal growth restriction (RR = 0.46 (95% CI, 0.33–0.64) vs 0.98 (95% CI, 0.88–1.08), P < 0.001) and preterm birth (RR = 0.35 (95% CI, 0.22–0.57) vs 0.90 (95% CI, 0.83–0.97), P < 0.001).ConclusionLow‐dose aspirin initiated at ≤ 16 weeks of gestation is associated with a greater reduction of perinatal death and other adverse perinatal outcomes than when initiated at >16 weeks. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.

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Wiley

Tập 41 Số 5

491-499

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