Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data.
BACKGROUND
Pre-eclampsia is a major cause of mortality and morbidity during pregnancy and childbirth. Antiplatelet agents, especially low-dose aspirin, might prevent or delay pre-eclampsia, and thereby improve outcome. Our aim was to assess the use of antiplatelet agents for the primary prevention of pre-eclampsia, and to explore which women are likely to benefit most.


METHODS
We did a meta-analysis of individual patient data from 32,217 women, and their 32,819 babies, recruited to 31 randomised trials of pre-eclampsia primary prevention.


RESULTS
For women assigned to receive antiplatelet agents rather than control, the relative risk of developing pre-eclampsia was 0.90 (95% CI 0.84-0.97), of delivering before 34 weeks was 0.90 (0.83-0.98), and of having a pregnancy with a serious adverse outcome was 0.90 (0.85-0.96). Antiplatelet agents had no significant effect on the risk of death of the fetus or baby, having a small for gestational age infant, or bleeding events for either the women or their babies. No particular subgroup of women was substantially more or less likely to benefit from antiplatelet agents than any other.


CONCLUSIONS
Antiplatelet agents during pregnancy are associated with moderate but consistent reductions in the relative risk of pre-eclampsia, of birth before 34 weeks' gestation, and of having a pregnancy with a serious adverse outcome.
Askie
Lisa M
LM
Centre for Perinatal Health Services Research, University of Sydney, Sydney, Australia; NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia; UK Cochrane Centre, Oxford, UK. Electronic address: laskie@ctc.usyd.edu.au.
Duley
Lelia
L
Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Henderson-Smart
David J
DJ
Centre for Perinatal Health Services Research, University of Sydney, Sydney, Australia.
Stewart
Lesley A
LA
Centre for Reviews and Dissemination, University of York, UK.
D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011225:Pre-Eclampsia / Q000503:physiopathology / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin