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Aspirin Prophylaxis During Pregnancy: A Systematic Review and Meta-Analysis

  • Yeo Jin Choi
    Affiliations
    Department of Clinical Pharmacy, Graduate School of Clinical Pharmacy, CHA University, Seongnam, Republic of Korea
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  • Sooyoung Shin
    Correspondence
    Address correspondence to: Sooyoung Shin, PharmD, PhD, Department of Clinical Pharmacy, College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea
    Affiliations
    Department of Clinical Pharmacy, College of Pharmacy, Ajou University, Suwon, Republic of Korea

    Research Institute of Pharmaceutical Science and Technology (RIPST), Ajou University, Suwon, Republic of Korea
    Search for articles by this author

      Context

      Low-dose aspirin is used for pre-eclampsia prophylaxis during pregnancy, but a study that comprehensively investigates both maternal and perinatal outcomes from aspirin administration utilizing stratification methods is lacking. The aim of this study is to comprehensively investigate the maternal and neonatal outcomes related to aspirin prophylaxis during pregnancy in relation to dose and therapy initiation by utilizing a stratification method.

      Evidence acquisition

      Placebo-controlled randomized trials investigating the effect of low-dose aspirin on maternal or perinatal outcomes with sufficient raw data and published in English from inception to August 2020 were searched for from PubMed, Embase, Cochrane Library, and Google Scholar in accordance with PRISMA guidelines. Review articles, editorials, case reports, conference abstracts, and nonplacebo-controlled studies were excluded.

      Evidence synthesis

      A total of 35 placebo-controlled randomized trials with 46,568 pregnant women were included in this meta-analysis. Aspirin prophylaxis substantially lowered the risk of pre-eclampsia, preterm birth, perinatal mortality, and intrauterine growth retardation without elevated bleeding risks. Low-dose aspirin considerably enhanced neonatal birth weight but did not decrease the risk of gestational hypertension. The subgroup analysis revealed substantially reduced pre-eclampsia risk and enhanced birth weight and gestational age at delivery in women who initiated aspirin before 20 weeks of gestation (RR=0.76, 95% CI=0.64, 0.90, p=0.001). However, the effect of aspirin dose on pregnancy outcomes was insignificant and requires further evaluation.

      Conclusions

      Initiation of low-dose aspirin administration before 20 weeks of gestation considerably decreases the incidence of pre-eclampsia and related neonatal outcomes without increasing bleeding risk.
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