- Date de publication : 2017-11-15
Roberge S, Bujold E, Nicolaides KH. Aspirin for the prevention of preterm and term preeclampsia: Systematic review and meta-analysis. Am. J. Obstet. Gynecol. 2017;:. doi: 10.1016/j.ajog.2017.11.561. PubMed PMID: 29138036.
Meta-analyses of randomized controlled trials have reported contradictory results concerning the effect of aspirin in the prevention of preeclampsia both in terms of the gestational age at the onset of treatment and the dose of the drug. The controversy may be resolved by a meta-analysis that includes several recently published trials and particularly the large Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention (ASPRE) trial and by examining whether there is a difference of the effect of aspirin on preterm vs. term preeclampsia.The primary outcome measure for this analysis was preterm preeclampsia with delivery at <37 weeks of gestation and the secondary outcome was term preeclampsia with delivery at ≥37 weeks. Preplanned subgroup analyses were examination of the effect of aspirin on preeclampsia, depending on gestational age at onset of therapy (≤16 and >16 weeks) and daily dose of the drug (<100 and ≥100 mg), both in the whole population and in the subgroup of trials considered to be of high quality.We performed a systematic review and meta-analysis that evaluated the prophylactic effect of aspirin during pregnancy. We completed a literature search through PubMed, Cinhal, Embase, Web of Science and Cochrane library from 1985 to June 2017. Relative risks (RR) with random effect were calculated with their 95% confidence intervals (95% CI).Sixteen trials including 18,907 participants provided data for preterm and term preeclampsia. Eight of the included studies were evaluated as being of good quality and the other eight of poor or uncertain quality. There was high heterogeneity within studies (I(2) >50%) for preterm and term preeclampsia, but no heterogeneity was found in the subgroup of preterm preeclampsia when the onset of treatment was ≤16 weeks and the daily dose of aspirin was ≥100 mg (I(2)=0%). Administration of aspirin was associated with reduction in the risk of preterm preeclampsia (RR: 0.62, 95% CI 0.45 to 0.87), but there was no significant effect on term preeclampsia (RR: 0.92, 95% CI 0.70 to 1.21). The reduction in preterm preeclampsia was confined to the subgroup in which aspirin was initiated at ≤16 weeks' gestation and at a daily dose of ≥100 mg (RR: 0.33, 95% CI 0.19 to 0.57). This effect was also observed in the high-quality studies. The reduction in preterm preeclampsia observed in the largest trial (ASPRE; n=1620; RR: 0.38; 95% CI: 0.20 to 0.72) was similar to that in the five smaller trials in which aspirin was initiated at ≤16 weeks' gestation and at a daily dose of ≥100 mg (n=639; RR: 0.22; 95% CI: 0.07 to 0.66).Aspirin reduces the risk of preterm preeclampsia but not term preeclampsia, and only when it is initiated at ≤16 weeks of gestation and at a daily dose of ≥100 mg.