Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis.
OBJECTIVE
To estimate the effect of low-dose aspirin started in early pregnancy on the incidence of preeclampsia and intrauterine growth restriction (IUGR).


METHODS
A systematic review and meta-analysis were performed through electronic database searches (PubMed, Cochrane, Embase).


METHODS
Randomized controlled trials of pregnant women at risk of preeclampsia who were assigned to receive aspirin or placebo (or no treatment) were reviewed. Secondary outcomes included IUGR, severe preeclampsia and preterm birth. The effect of aspirin was analyzed as a function of gestational age at initiation of the intervention (16 weeks of gestation or less, 16 weeks of gestation or more).


RESULTS
Thirty-four randomized controlled trials met the inclusion criteria, including 27 studies (11,348 women) with follow-up for the outcome of preeclampsia. Low-dose aspirin started at 16 weeks or earlier was associated with a significant reduction in preeclampsia (relative risk [RR] 0.47, 95% confidence interval [CI] 0.34-0.65, prevalence in 9.3% treated compared with 21.3% control) and IUGR (RR 0.44, 95% CI 0.30-0.65, 7% treated compared with 16.3% control), whereas aspirin started after 16 weeks was not (preeclampsia: RR 0.81, 95% CI 0.63-1.03, prevalence in 7.3% treated compared with 8.1% control; IUGR: RR 0.98, 95% CI 0.87-1.10, 10.3% treated compared with 10.5% control). Low-dose aspirin started at 16 weeks or earlier also was associated with a reduction in severe preeclampsia (RR 0.09, 95% CI 0.02-0.37, 0.7% treated compared with 15.0% control), gestational hypertension (RR 0.62, 95% CI 0.45-0.84, 16.7% treated compared with 29.7% control), and preterm birth (RR 0.22, 95% CI 0.10-0.49, 3.5% treated compared with 16.9% control). Of note, all studies for which aspirin had been started at 16 weeks or earlier included women identified to be at moderate or high risk for preeclampsia.


CONCLUSIONS
Low-dose aspirin initiated in early pregnancy is an efficient method of reducing the incidence of preeclampsia and IUGR.
Bujold
Emmanuel
E
From the Department of Obstetrics and Gynecology, Faculty of Medicine, Laval University, Québec, Canada; the Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Québec, Canada; Centre de Recherche, Centre Hospitalier Universitaire de Québec, Québec, Canada; Centre de Recherche, Hôpital Laval, Institut Universitaire de Cardiologie et Pneumologie, Laval University, Québec, Canada; the Department of Obstetrics and Gynecology, Faculty of Medicine, University of Montreal, Montréal, Québec, Canada; and the Department of Molecular Biology, Medical Biology and Pathology, Faculty of Medicine, Laval University, Québec, Canada.
Roberge
Stéphanie
S
Lacasse
Yves
Y
Bureau
Marc
M
Audibert
François
F
Marcoux
Sylvie
S
Forest
Jean-Claude
JC
Giguère
Yves
Y
D001241:Aspirin / Q000008:administration & dosage*; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology / Q000517:prevention & control*; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000517:prevention & control*; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin