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Daily low-dose aspirin slightly reduced preeclampsia risk in pregnant women
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In pregnant women at high risk for preeclampsia, a daily regimen of low-dose aspirin initiated as early as the second trimester may help to prevent preeclampsia-related events, according to recent findings from the US Preventive Services Task Force.
However, these results do not rule out possible rare or long-term adverse events resulting from a low-dose aspirin regimen in this population, the researchers wrote.
Researchers performed a systematic review of randomized controlled trials evaluating the benefits of aspirin prophylaxis among women at high risk of preeclampsia. Eligible trials identified preeclampsia risk based on medical history, pregnancy characteristics or clinical factors associated with preeclampsia risk.
Twenty-three studies were included, including two large multicenter trials and 13 smaller trials of women at high preeclampsia risk, and six randomized trials and two observational studies assessing a daily low-dose aspirin regimen among women at average risk for preeclampsia. All trials were published between 2006 and June 1, 2013. Potential harm from an aspirin regimen was assessed in 21 trials, including all studies assessing a high-risk cohort.
The mean age of the participants was 20.3 to 31 years, and they were predominantly white. The daily aspirin dose ranged from 60 mg to 150 mg, with 60 mg and 100 mg the most commonly administered dose (used in six and eight trials, respectively).
After factoring in risk at baseline, a low-dose aspirin regimen was linked to absolute risk reductions of 2% to 5% for preeclampsia (RR=0.76; 95% CI, 0.62-0.95 across 13 trials of 12,184 participants), with moderate heterogeneity (I2=40.5%; P=.064) and evidence of small-study effects observed (P=.028). Aspirin use was also related to absolute risk reductions of 1% to 5% for intrauterine growth restriction (RR=0.8; 95% CI, 0.65-0.99 across 13 trials of 12,504 participants) and of 2% to 4% for preterm birth (RR=0.86; 95% CI, 0.76-0.98 across 10 trials of 11,799 participants).
Based on a fixed-effects pooled estimate from 10 trials of high-risk women, researchers observed a possible reduced risk of perinatal death with low-dose aspirin use (RR=0.81; 95% CI, 0.65-1.01); but this was not statistically significant. Results from 11 trials that addressed placental abruption suggested a possible increase in the risk for this event (RR=1.17; 95% CI, 0.93-1.48 across 11 trials of 23,332 participants), but this was also not statistically significant.
No impact was observed from a low-dose aspirin regimen on perinatal mortality, postpartum or intracranial hemorrhage or mean blood loss. While long-term outcome data was scarce, 18-month follow-up from the largest trial did not report any developmental adverse effects. Sensitivity analyses did not alter the observed results for any of the evaluated potential benefits or harms from low-dose aspirin.
“More primary research is needed to illuminate how preeclampsia arising from different risk factors develops and responds to aspirin,” the researchers concluded. “… For women at high risk for preeclampsia, available evidence indicates modest effects but important benefits of daily low-dose aspirin for prevention of the condition and consequent illness.”
Disclosure: See the full study for a list of relevant financial disclosures.
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