Does Low-Dose Aspirin Initiated Before 11 Weeks’ Gestation Reduce the Rate of Preeclampsia?

Abstract

Condensation: Aspirin given at <11 weeks' gestation in high risk women does not reduce the risk of preeclampsia and gestational hypertension but may reduce the risk of preterm delivery. Short title: Early aspirin administration and preeclampsia PROSPERO registration number: CRD42019125006 AJOG at a Glance: Why was this study conducted? • To perform a systematic review and meta-analysis to evaluate the effect of lowdose aspirin initiated at <11 weeks' gestation on the risk of preeclampsia, gestational hypertension, or any hypertensive disorder of pregnancy. Secondary outcomes included preterm delivery at <37 weeks' gestation and fetal growth restriction. Key findings • The administration of low-dose aspirin at <11 weeks' gestation in women with a history of recurrent pregnancy loss, women who had undergone in vitro fertilization or women with thrombophilia or antiphospholipid syndrome was associated with a non-significant decrease in the risk of preeclampsia, gestational hypertension, and any hypertensive disorder of pregnancy. • Early low-dose aspirin reduced the risk of preterm delivery but had no impact on the risk of fetal growth restriction. • Except for preterm delivery and any hypertensive disorder of pregnancy, sensitivity analysis demonstrated similar observations; confirming the robustness of our analysis. What does this add to what is known? • Administration of low-dose aspirin at <11 weeks' gestation to high risk women does not reduce the risk of preeclampsia, gestational hypertension, any hypertensive disorder of pregnancy and fetal growth restriction but might reduce the risk of preterm delivery at <37 weeks of gestation. ABSTRACT OBJECTIVE DATA: Pre-conception or early administration of low-dose aspirin might improve endometrial growth, placental vascularization and organogenesis. Most studies have evaluated the potential benefit of pre-conception or early administration of low-dose aspirin in women with a history of recurrent pregnancy loss, women who have undergone in vitro fertilization or women with thrombophilia or antiphospholipid syndrome. These women are at an increased risk of placenta-associated complications of pregnancy, including preeclampsia, preterm delivery and fetal growth restriction. STUDY: We performed a systematic review and meta-analysis to evaluate the effect of low-dose aspirin initiated at <11 weeks' gestation on the risk of preeclampsia, gestational hypertension, or any hypertensive disorder of pregnancy. Secondary outcomes included preterm delivery at <37 weeks' gestation and fetal growth restriction. STUDY APPRAISAL AND SYNTHESIS METHODS: We searched in MEDLINE via PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.Gov and the World Health Organization International Clinical Trials Registry Platform (WHO-ICTRP) from 1985 to November 2018. Entry criteria were randomized controlled trials evaluating the effect of aspirin administered at <11 weeks' gestation in preventing preeclampsia and/or hypertensive disorders in pregnancy or improvi...

Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review

“…NSAIDs, [38][39][40][41][42][43][44][45] two antiepileptics, [46][47][48] two β-blockers, [49][50][51] two calcium channel blockers, 50,52 two antiemetics (5-HT3 receptor antagonists), 53,54 two antipsychotics, 55,56 two antihistamines, 57,58 and one each assessed serotonin and norepinephrine reuptake inhibitors (SNRIs), 59,60 tricyclic antidepressants, 59,60 benzodiazepines, 61,62 corticosteroids, 63 oral magnesium, 64 triptans (5-HT1B/1D receptor agonists), 65 analgesics/antipyretics, 66 and intravenous magnesium. 67 Twelve SRs reported maternal adverse effects and 23 reported fetal/child adverse effects.…”

Prospective evaluation of first‐trimester screening strategy for preterm pre‐eclampsia and its clinical applicability in China

“…Application of the FMF screening method and administration of low-dose aspirin (150 mg daily) to women who screen positive can significantly reduce the incidence of preterm PE (odds ratio (OR), 0.38 (95% CI, 0.20-0.74)) 13 . Furthermore, systematic reviews of randomized trials suggest that low-dose aspirin could potentially reduce the frequency of other placenta-mediated complications of pregnancy, such as intrauterine growth restriction, preterm delivery and placental abruption [14][15][16][17][18][19] .…”

Preventive effect of aspirin on preeclampsia in high‐risk pregnant women with stage 1 hypertension

“…A study showed that the preventive effect of aspirin on preterm PE was substantial, and a comparison of the incidence of PE between the aspirin and placebo groups showed no significant difference 23 . A recent systematic review and meta‐analysis reported that the administration of low‐dose aspirin at <11 weeks of gestation in high‐risk women does not decrease the risk of PE, but it might reduce the risk of preterm delivery 24 . Combined with the results of previous study indicating that the minimal effect of aspirin in the prevention of preterm PE in pregnancies with chronic hypertension, the specific high‐risk population and active window for aspirin use need to be clarified.…”

“…23 A recent systematic review and meta-analysis reported that the administration of low-dose aspirin at <11 weeks of gestation in high-risk women does not decrease the risk of PE, but it might reduce the risk of preterm delivery. 24 Combined with the results of previous study indicating that the minimal effect of aspirin in the prevention of preterm PE in pregnancies with chronic hypertension, the specific high-risk population and active window for aspirin use need to be clarified. Our research indicated that although aspirin treatment does not seem to be efficient to prevent PE in chronic hypertension, it seems that considering stage 1 hypertension the stage 1 hypertension may be an additional risk factor for PE prevention of aspirin.…”