January 29, 2013Ultrasound in Obstetrics and Gynecology
Prevention of perinatal death and adverse perinatal outcome using low‐dose aspirin: a meta‐analysis
Why the study?
Does low-dose aspirin initiated at ≤ 16 weeks of gestation reduce perinatal death and adverse perinatal outcomes compared to initiation at > 16 weeks in pregnant women at risk for pre-eclampsia?
Population
42 RCTs pooling 27,222 pregnant women with risk factors for pre-eclampsia.
Comparison
Low-dose aspirin initiated at ≤ 16 weeks of… vs Low-dose aspirin initiated at > 16 weeks of…
Design
Meta-analysis
Authors
Discussion
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Implication
Early aspirin initiation (≤16 weeks) may be prioritized in pre-eclampsia risk; extends meta-analytic evidence on timing for perinatal survival.
Key Points
- To compare the effect of early versus late initiation of prophylactic low-dose aspirin on perinatal death and other adverse perinatal outcomes in high-risk pregnancies.
- Systematic review and meta-analysis of 42 randomized controlled trials comprising 27,222 pregnant women with risk factors for pre-eclampsia.
- Evaluated prophylactic low-dose aspirin (50–150 mg/day) initiated at ≤ 16 weeks versus > 16 weeks of gestation.
- Primary outcome was combined fetal and neonatal death, assessed via pooled relative risks (RR) with 95% confidence intervals.
- Aspirin initiated at ≤ 16 weeks significantly reduced perinatal death compared to initiation at > 16 weeks (RR = 0.41, 95% CI 0.19–0.92 vs RR = 0.93, 95% CI 0.73–1.19; P = 0.02).
- Early initiation achieved greater reductions in pre-eclampsia (RR = 0.47, 95% CI 0.36–0.62 vs RR = 0.78, 95% CI 0.61–0.99; P < 0.01) and severe pre-eclampsia (RR = 0.18, 95% CI 0.08–0.41 vs RR = 0.65, 95% CI 0.40–1.07; P < 0.01).
- Fetal growth restriction (RR = 0.46, 95% CI 0.33–0.64 vs RR = 0.98, 95% CI 0.88–1.08; P < 0.001) and preterm birth (RR = 0.35, 95% CI 0.22–0.57 vs RR = 0.90, 95% CI 0.83–0.97; P < 0.001) were also substantially lower with early initiation.
Structured PICO
Does low-dose aspirin initiated at ≤ 16 weeks of gestation reduce perinatal death and adverse perinatal outcomes compared to initiation at > 16 weeks in pregnant women at risk for pre-eclampsia?
P
Population
42 RCTs pooling 27,222 pregnant women with risk factors for pre-eclampsia (including nulliparity, multiple pregnancy, chronic hypertension, cardiovascular or endocrine disease, prior gestational hypertension or fetal growth restriction, and/or abnormal uterine artery Doppler).
I
Intervention
Low-dose aspirin (50-150 mg/day) initiated at ≤ 16 weeks of gestation.
C
Comparator
Low-dose aspirin initiated at > 16 weeks of gestation.
O
Outcome
Composite of fetal and neonatal death (perinatal death).composite
Initiating low-dose aspirin at or before 16 weeks of gestation significantly reduces perinatal death and adverse perinatal outcomes in women at risk for pre-eclampsia compared to later initiation.
Cite This Study
Roberge et al. (2013) studied this question.