Aspirin for prevention of preeclampsia in women with historical risk factors: a systematic review.
OBJECTIVE
To examine the effectiveness of aspirin in preventing perinatal death and preeclampsia in women with predisposing historical risk factors, such as previous history of preeclampsia, chronic hypertension, diabetes, and renal disease.


METHODS
Searches were conductes in Medline, Embase, Cochrane Library, National Research Register, SCISEARCH, AND ISI Conference Proceedings without any language restrictions, using the following medical subject headings and text words: "aspirin," "antiplatelet*," "salicyl*," "acetylsalicyl*," "platelet aggregation inhibitors," "pre-eclamp*," "preeclamp*," and "hypertens*.


METHODS
We included all randomized trials that evaluated the effectiveness of aspirin compared with placebo or no treatment in women with predisposing historical risk factors and reported clinically relevant perinatal or maternal outcomes. Study selection, quality appraisal, and data extractions were performed independently and in duplicate.We identified 14 relevant trials, including a total of 12,416 women. Meta-analysis showed a significant benefit of aspirin therapy in reducing perinatal death (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.64, 0.96) and preeclampsia (OR 0.86, 95% CI 0.76, 0.96). Aspirin was also associated with a reduction in rates of spontaneous preterm birth (OR 0.86, 95% CI 0.79, 0.94), and an increase of 215 g in mean birth weight (weighted mean difference 215, 95% CI 90, 341). There was no increase in the risk of placental abruption with aspirin (OR 0.98, 95% CI 0.79, 1.21). Funnel plot analysis indicated that publication and related biases were unlikely (Egger test, P =.84).


CONCLUSIONS
Aspirin reduces the risk of perinatal death and preeclampsia in women with historical risk factors. Given the importance of these outcomes and the safety and low cost of aspirin, aspirin therapy should be considered in women with historical risk factors.
Coomarasamy
Aravinthan
A
Education Resource Centre, Birmingham Women's Hospital, Birmingham, United Kingdom. arricoomar@blueyonder.co.uk
Honest
Honest
H
Papaioannou
Spyros
S
Gee
Harry
H
Khan
Khalid Saeed
KS
D001241:Aspirin / Q000627:therapeutic use*; D001724:Birth Weight; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007752:Obstetric Labor, Premature / Q000517:prevention & control; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011225:Pre-Eclampsia / Q000517:prevention & control*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin