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Prevention of Preeclampsia and Intrauterine Growth Restriction With Aspirin Started in Early Pregnancy: A Meta-Analysis

Bujold, Emmanuel MD, MSc; Roberge, Stéphanie MSc; Lacasse, Yves MD, MSc; Bureau, Marc MD; Audibert, François MD, MSc; Marcoux, Sylvie MD, PhD; Forest, Jean-Claude MD, PhD; Giguère, Yves MD, PhD

doi: 10.1097/AOG.0b013e3181e9322a
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OBJECTIVE: To estimate the effect of low-dose aspirin started in early pregnancy on the incidence of preeclampsia and intrauterine growth restriction (IUGR).

DATA SOURCES: A systematic review and meta-analysis were performed through electronic database searches (PubMed, Cochrane, Embase).

METHODS OF STUDY SELECTION: Randomized controlled trials of pregnant women at risk of preeclampsia who were assigned to receive aspirin or placebo (or no treatment) were reviewed. Secondary outcomes included IUGR, severe preeclampsia and preterm birth. The effect of aspirin was analyzed as a function of gestational age at initiation of the intervention (16 weeks of gestation or less, 16 weeks of gestation or more).

TABULATION, INTEGRATION, AND RESULTS: Thirty-four randomized controlled trials met the inclusion criteria, including 27 studies (11,348 women) with follow-up for the outcome of preeclampsia. Low-dose aspirin started at 16 weeks or earlier was associated with a significant reduction in preeclampsia (relative risk [RR] 0.47, 95% confidence interval [CI] 0.34–0.65, prevalence in 9.3% treated compared with 21.3% control) and IUGR (RR 0.44, 95% CI 0.30–0.65, 7% treated compared with 16.3% control), whereas aspirin started after 16 weeks was not (preeclampsia: RR 0.81, 95% CI 0.63–1.03, prevalence in 7.3% treated compared with 8.1% control; IUGR: RR 0.98, 95% CI 0.87–1.10, 10.3% treated compared with 10.5% control). Low-dose aspirin started at 16 weeks or earlier also was associated with a reduction in severe preeclampsia (RR 0.09, 95% CI 0.02–0.37, 0.7% treated compared with 15.0% control), gestational hypertension (RR 0.62, 95% CI 0.45–0.84, 16.7% treated compared with 29.7% control), and preterm birth (RR 0.22, 95% CI 0.10–0.49, 3.5% treated compared with 16.9% control). Of note, all studies for which aspirin had been started at 16 weeks or earlier included women identified to be at moderate or high risk for preeclampsia.

CONCLUSION: Low-dose aspirin initiated in early pregnancy is an efficient method of reducing the incidence of preeclampsia and IUGR.

Low-dose aspirin started before 16 weeks of gestation decreases the rate of preeclampsia and intrauterine growth restriction in women at increased risk for preeclampsia.

From the Department of Obstetrics and Gynecology, Faculty of Medicine, Laval University, Québec, Canada; the Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Québec, Canada; Centre de Recherche, Centre Hospitalier Universitaire de Québec, Québec, Canada; Centre de Recherche, Hôpital Laval, Institut Universitaire de Cardiologie et Pneumologie, Laval University, Québec, Canada; the Department of Obstetrics and Gynecology, Faculty of Medicine, University of Montreal, Montréal, Québec, Canada; and the Department of Molecular Biology, Medical Biology and Pathology, Faculty of Medicine, Laval University, Québec, Canada.

Dr. Emmanuel Bujold holds a Clinician Scientist Award and Dr. François Audibert holds a New Investigator Award from the Canadian Institutes of Health Research (CIHR). Dr. Yves Giguère holds a Clinician-Scientist Award from Fonds de la recherche en santé du Québec (FRSQ). Supported by the Jeanne and Jean-Louis Lévesque Perinatal Research Chair at Université Laval.

Corresponding author: Emmanuel Bujold, MD, MSc, FRCSC, Associate Professor, Department of Obstetrics and Gynaecology, CRCHUQ, Faculty of Medicine, Université Laval, 2705, boulevard Laurier, Québec, QC, Canada G1V 4G2; email: emmanuel.bujold@crchul.ulaval.ca.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2010 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.