Abstract
ObjectiveTo evaluate the effect of aspirin dose on the incidence of all gestational age preeclampsia and preterm preeclampsia.Data sourcesElectronic databases (Cochrane, PubMed, Scopus, ClinicalTrials.gov and the Web of Science) were searched for articles published between January 1985 and March 2019 with no language restrictions.MethodsWe followed the PRIMSA guidelines and utilized Covidence software. Articles were screened by 2 independent reviewers, with discrepancies settled by an independent 3rd party. Study selection criteria were randomized trials comparing aspirin for prevention of all gestational age and preterm preeclampsia to placebo or no antiplatelet treatment in women aged 15–55 years with moderate or high-risk factors according to the list of risk factors from American College of Obstetricians and Gynecologists and United States Preventive Services Task Force guidelines. The quality of trials was assessed using the Cochrane risk of bias tool. The data were pooled using a random-effects meta-analysis comparing aspirin at doses of <81, 81, 100, and 150 mg. Pre-specified outcomes were all gestational age and preterm preeclampsia.ResultsOf 1,609 articles screened, 23 randomized trials, which included 32,370 women, fulfilled the inclusion criteria. In preterm preeclampsia, women assigned at random to 150 mg experienced a significant 62% reduction in risk of preterm preeclampsia (RR = 0.38; 95% CI: 0.20–0.72; P = 0.011). Aspirin doses <150 mg produced no significant reductions. The number needed to treat with 150 mg of aspirin was 39 (95% CI: 23–100). There was a maximum 30% reduction in risk of all gestational age preeclampsia at all aspirin doses.ConclusionsIn this meta-analysis, based on indirect comparisons, aspirin at a dose greater than the current, recommended 81 mg was associated with the highest reduction in preterm preeclampsia. Our meta-analysis is limited due to the deficiency of homogeneous high evidence data available in the literature to date; however, it may be prudent for clinicians to consider that the optimal aspirin dose may be higher than the current guidelines advise. Future research to compare the efficacy aspirin doses greater than 81 mg is recommended.Study registrationPROSPERO, CRD42019127951 (University of York, UK; http://www.crd.york.ac.uk/PROSPERO/).
Highlights
Hypertensive disorders of pregnancy are a leading cause of maternal morbidity and mortality worldwide, accounting for more than 70,000 maternal deaths each year [1]
Women assigned at random to 150 mg experienced a significant 62% reduction in risk of preterm preeclampsia (RR = 0.38; 95% CI: 0.20–0.72; P = 0.011)
There was a maximum 30% reduction in risk of all gestational age preeclampsia at all aspirin doses. In this meta-analysis, based on indirect comparisons, aspirin at a dose greater than the current, recommended 81 mg was associated with the highest reduction in preterm preeclampsia
Summary
Hypertensive disorders of pregnancy are a leading cause of maternal morbidity and mortality worldwide, accounting for more than 70,000 maternal deaths each year [1]. While randomized trials have investigated the prophylactic use of aspirin in preventing preeclampsia, the optimal dose remains unclear. 150 mg of daily aspirin in pregnant women deemed high-risk for developing preeclampsia, significantly decreased the incidence of preterm preeclampsia when compared to placebo [5]. In a recent systematic review, the authors concluded that aspirin beginning at or before 16 weeks gestation reduces the incidence of preeclampsia and its adverse outcomes among pregnant women and neonates [6]. We performed a systematic review and meta-analysis of 23 randomized controlled trials to explore whether aspirin is effective and, if so, the optimal dose for women with moderate or high-risk factors of preeclampsia. Our primary objective was to determine the effect of aspirin dose on the incidence of all gestational age and preterm preeclampsia
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
