BACKGROUND: Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality. PURPOSE: To systematically review benefits and harms of low-dose aspirin for preventing morbidity and mortality from preeclampsia. DATA SOURCES: MEDLINE, Database of Abstracts of Reviews of Effects, PubMed, and Cochrane Central Register of Controlled Trials (January 2006 to June 2013); previous systematic reviews, clinical trial registries, and surveillance searches for large studies (June 2013 to February 2014). STUDY SELECTION: Randomized, controlled trials (RCTs) to assess benefits among women at high preeclampsia risk and RCTs or large cohort studies of harms among women at any risk level. English-language studies of fair or good quality were included. DATA EXTRACTION: Dual quality assessment and abstraction of studies. DATA SYNTHESIS: Two large, multisite RCTs and 13 smaller RCTs of high-risk women (8 good-quality) were included, in addition to 6 RCTs and 2 observational studies of average-risk women to assess harms (7 good-quality). Depending on baseline risk, aspirin use was associated with absolute risk reductions of 2% to 5% for preeclampsia (relative risk [RR], 0.76 [95% CI, 0.62 to 0.95]), 1% to 5% for intrauterine growth restriction (RR, 0.80 [CI, 0.65 to 0.99]), and 2% to 4% for preterm birth (RR, 0.86 [CI, 0.76 to 0.98]). No significant perinatal or maternal harms were identified, but rare harms could not be ruled out. Evidence on long-term outcomes was sparse, but 18-month follow-up from the largest trial found no developmental harms. LIMITATIONS: Benefits may have been overestimated due to small-study effects. Predictive intervals were not statistically significant. Future studies could shift findings toward the null. CONCLUSION: Daily low-dose aspirin beginning as early as the second trimester prevented clinically important health outcomes. No harms were identified, but long-term evidence was limited.
BACKGROUND: Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality. PURPOSE: To systematically review benefits and harms of low-dose aspirin for preventing morbidity and mortality from preeclampsia. DATA SOURCES: MEDLINE, Database of Abstracts of Reviews of Effects, PubMed, and Cochrane Central Register of Controlled Trials (January 2006 to June 2013); previous systematic reviews, clinical trial registries, and surveillance searches for large studies (June 2013 to February 2014). STUDY SELECTION: Randomized, controlled trials (RCTs) to assess benefits among women at high preeclampsia risk and RCTs or large cohort studies of harms among women at any risk level. English-language studies of fair or good quality were included. DATA EXTRACTION: Dual quality assessment and abstraction of studies. DATA SYNTHESIS: Two large, multisite RCTs and 13 smaller RCTs of high-risk women (8 good-quality) were included, in addition to 6 RCTs and 2 observational studies of average-risk women to assess harms (7 good-quality). Depending on baseline risk, aspirin use was associated with absolute risk reductions of 2% to 5% for preeclampsia (relative risk [RR], 0.76 [95% CI, 0.62 to 0.95]), 1% to 5% for intrauterine growth restriction (RR, 0.80 [CI, 0.65 to 0.99]), and 2% to 4% for preterm birth (RR, 0.86 [CI, 0.76 to 0.98]). No significant perinatal or maternal harms were identified, but rare harms could not be ruled out. Evidence on long-term outcomes was sparse, but 18-month follow-up from the largest trial found no developmental harms. LIMITATIONS: Benefits may have been overestimated due to small-study effects. Predictive intervals were not statistically significant. Future studies could shift findings toward the null. CONCLUSION: Daily low-dose aspirin beginning as early as the second trimester prevented clinically important health outcomes. No harms were identified, but long-term evidence was limited.
Authors: Scott W Walsh; Daniel T Reep; S M Khorshed Alam; Sonya L Washington; Marwah Al Dulaimi; Stephanie M Lee; Edward H Springel; Jerome F Strauss; Daniel J Stephenson; Charles E Chalfant Journal: Reprod Sci Date: 2020-06-17 Impact factor: 3.060
Authors: Matthew K Hoffman; Shivaprasad S Goudar; Bhalachandra S Kodkany; Mrityunjay Metgud; Manjunath Somannavar; Jean Okitawutshu; Adrien Lokangaka; Antoinette Tshefu; Carl L Bose; Abigail Mwapule; Musaku Mwenechanya; Elwyn Chomba; Waldemar A Carlo; Javier Chicuy; Lester Figueroa; Ana Garces; Nancy F Krebs; Saleem Jessani; Farnaz Zehra; Sarah Saleem; Robert L Goldenberg; Kunal Kurhe; Prabir Das; Archana Patel; Patricia L Hibberd; Emmah Achieng; Paul Nyongesa; Fabian Esamai; Edward A Liechty; Norman Goco; Jennifer Hemingway-Foday; Janet Moore; Tracy L Nolen; Elizabeth M McClure; Marion Koso-Thomas; Menachem Miodovnik; R Silver; Richard J Derman Journal: Lancet Date: 2020-01-25 Impact factor: 79.321
Authors: Liona C Poon; Andrew Shennan; Jonathan A Hyett; Anil Kapur; Eran Hadar; Hema Divakar; Fionnuala McAuliffe; Fabricio da Silva Costa; Peter von Dadelszen; Harold David McIntyre; Anne B Kihara; Gian Carlo Di Renzo; Roberto Romero; Mary D'Alton; Vincenzo Berghella; Kypros H Nicolaides; Moshe Hod Journal: Int J Gynaecol Obstet Date: 2019-05 Impact factor: 3.561
Authors: Alan Leviton; Robert M Joseph; Elizabeth N Allred; T Michael O'Shea; Karl K C Kuban Journal: Early Hum Dev Date: 2018-02-07 Impact factor: 2.079
Authors: Sabrina M Scroggins; Donna A Santillan; Jenna M Lund; Jeremy A Sandgren; Lindsay K Krotz; Wendy S Hamilton; Eric J Devor; Heather A Davis; Gary L Pierce; Katherine N Gibson-Corley; Curt D Sigmund; Justin L Grobe; Mark K Santillan Journal: Clin Sci (Lond) Date: 2018-02-14 Impact factor: 6.124