Comparing aspirin 75 to 81 mg vs 150 to 162 mg for prevention of preterm preeclampsia: systematic review and meta-analysis

Ghesquière, Louise; Guerby, Paul; Marchant, Isobel; Kumar, Namrata; Zare, Marjan; Foisy, Marie-Anne; Roberge, Stéphanie; Bujold, Emmanuel

doi:10.1016/j.ajogmf.2023.101000

Cited by 14 publications

(5 citation statements)

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“…At 50-60 mg, the beneficial effect of aspirin was absent, whereas the effect became highly significant at 100 mg daily. Finally, in a previous meta-analysis of randomized trials comparing 75-81 mg versus 150-162 mg, we found that an aspirin dosage of 150-162 mg was associated with a significant reduction in preterm PE compared to an aspirin dosage of 75-81 mg (RR = 0.34; 95% CI, 0.15-0.79; p = 0.01; I2 = 0%) [36]. A recent randomized trial that was not included in our meta-analysis came to the same conclusion [37].…”

Section: Discussionmentioning

confidence: 75%

Aspirin at 75 to 81 mg Daily for the Prevention of Preterm Pre-Eclampsia: Systematic Review and Meta-Analysis

Demuth,

Pellan,

Boutin

et al. 2024

JCM

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Background: Aspirin at 150 mg daily, initiated in the 1st trimester of pregnancy, prevents preterm pre-eclampsia. We aimed to estimate whether a dose of 75 to 81 mg daily can help to prevent preterm pre-eclampsia as well. Methods: A systematic search was conducted using multiple databases and meta-analyses of randomized controlled trials (RCTs) that compared aspirin initiated in the first trimester of pregnancy to placebo or no treatment, following the PRISMA guidelines and the Cochrane risk of bias tool. Results: We retrieved 11 RCTs involving 13,981 participants. Five RCTs had a low risk of bias, one at unclear risk, and fiver had a high risk of bias. A pooled analysis demonstrated that doses of 75 to 81 mg of aspirin, compared to a placebo or no treatment, was not associated with a significant reduction in preterm pre-eclampsia (8 studies; 12,391 participants; relative risk, 0.66; 95% confidence interval: 0.27 to 1.62; p = 0.36), but there was a significant heterogeneity across the studies (I2 = 61%, p = 0.02). Conclusion: It cannot be concluded that taking 75 to 81 mg of aspirin daily reduces the risk of preterm pre-eclampsia. However, given the significant heterogeneity between the studies, the true effect that such a dose of aspirin would have on pregnancy outcomes could not be properly estimated.

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Section: Discussionmentioning

confidence: 75%

Aspirin at 75 to 81 mg Daily for the Prevention of Preterm Pre-Eclampsia: Systematic Review and Meta-Analysis

Demuth,

Pellan,

Boutin

et al. 2024

JCM

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“…In 2023, a systematic review and meta‐analysis were reported comparing 75–81 mg aspirin versus 150–162 mg 22 . The result was that 150–162 mg could reduce preterm PE significantly, compared with 75–81 mg.…”

Section: Prevention With Low‐dose Aspirinmentioning

confidence: 99%

First‐trimester preterm preeclampsia prediction model for prevention with low‐dose aspirin

Pooh

2024

J of Obstet and Gynaecol

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IntroductionPreeclampsia (PE) is a major maternal and fetal threat. Previous risk‐scoring methods in guidelines lacked precision. The Fetal Medicine Foundation (FMF) proposed a first‐trimester PE screening model using Bayes' theorem.PE Prediction ModelFMF prediction model combines maternal characteristics and medical/obstetrical history to determine prior risk and further incorporate maternal blood pressure, maternal serum biomarkers, and uterine Doppler pulsatility index expressed as multiples of the median (MoM) to estimate posterior risk.Low‐Dose Aspirin PreventionLow‐dose aspirin is one of the potential PE prevention strategies. Initiating it before 16 weeks is crucial. Aspirin's antiplatelet and anti‐inflammatory properties align with PE's pathophysiology. Dosing and resistance warrant further study, but a standard regimen of 150 mg nightly, starting before 16 weeks, is widely supported.PE Prevention in PracticeClinical trials, including ASPRE, affirm aspirin's role in PE prevention. Starting aspirin based on FMF screening significantly reduces preterm PE and associated complications.Advancements and ProspectsEmerging research explores predictors like maternal ophthalmic arterial waveform. Regional variations, especially in Asian populations, are considered. Machine learning and AI show promise, but examiner expertise remains essential for accurate prediction.In conclusion, integrating FMF's first‐trimester PE screening with low‐dose aspirin offers a promising strategy. Further advancements may enhance precision and broaden prevention efforts.

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“… 50 In this study, the use of 100 mg aspirin resulted in the lowest predicted rate of preterm preeclampsia of 1.6%. 50 Nevertheless, a recent meta-analysis favored 150–162 mg over 75–80 mg for preventing preterm preeclampsia, 51 although limited by few studies and methodological issues. 52 If a higher dose proves to be more effective, the impact would be greater for women in LMIC than in HIC.…”

Section: What Is the Optimal Aspirin Dosage?mentioning

confidence: 99%

Aspirin for preeclampsia prevention in low- and middle-income countries: mind the gaps

Kupka,

Roberts,

Mahdy

et al. 2024

AJOG Global Reports

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Comparing aspirin 75 to 81 mg vs 150 to 162 mg for prevention of preterm preeclampsia: systematic review and meta-analysis

Cited by 14 publications

References 50 publications

Aspirin at 75 to 81 mg Daily for the Prevention of Preterm Pre-Eclampsia: Systematic Review and Meta-Analysis

Aspirin at 75 to 81 mg Daily for the Prevention of Preterm Pre-Eclampsia: Systematic Review and Meta-Analysis

First‐trimester preterm preeclampsia prediction model for prevention with low‐dose aspirin

Aspirin for preeclampsia prevention in low- and middle-income countries: mind the gaps

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