- Date de publication : 2018-01-06
Roberge S, Bujold E, Nicolaides KH. Meta-analysis on the effect of aspirin use for prevention of preeclampsia on placental abruption and antepartum hemorrhage. Am. J. Obstet. Gynecol. 2018;:. doi: 10.1016/j.ajog.2017.12.238. PubMed PMID: 29305829.
Impaired placentation in the first 16 weeks of pregnancy is associated with increased risk of subsequent development of preeclampsia, birth of small for gestational age neonates and placental abruption. Previous studies reported that prophylactic use of aspirin reduces the risk of preeclampsia and small for gestational age neonates with no significant effect on placental abruption. However, meta-analyses of randomized controlled trials examining the effect of aspirin in relation to gestational age at onset of therapy and dose of the drug reported that significant reduction in the risk of preeclampsia and small for gestational age neonates is achieved only if the onset of treatment is at ≤16 weeks of gestation and the daily dose of the drug is ≥100 mg.To estimate the effect of aspirin on the risk of placental abruption or antepartum hemorrhage, in relation to gestational age at onset of therapy and the dose of the drug.We performed a systematic review and meta-analysis of randomized controlled trials that evaluated the prophylactic effect of aspirin during pregnancy using PubMed, Cinhal, Embase, Web of Science and Cochrane library from 1985 to September 2017. Relative risks (RR) of placental abruption or antepartum hemorrhage with their 95% confidence intervals (95% CI) were calculated using random effect models. Analyses were stratified according to daily dose of aspirin (<100 and ≥100 mg) and the gestational age at the onset of therapy (≤16 and >16 weeks) and compared using subgroup difference analysis.The entry criteria were fulfilled by 20 studies on a combined total of 12,585 participants. Aspirin at a dose of <100 mg per day had no impact on the risk of placental abruption or antepartum hemorrhage, irrespective of whether it was initiated at ≤16 weeks' gestation (RR 1.11, 95% CI 0.52 to 2.36) or at >16 weeks (RR 1.32, 95% CI 0.73 to 2.39). At ≥100 mg per day, aspirin was not associated with a significant change on the risk of placental abruption or antepartum hemorrhage, whether the treatment was initiated at ≤16 weeks of gestation (RR 0.62, 95% CI 0.31 to 1.26), or at >16 weeks (RR 2.08 95% CI 0.86 to 5.06), but the difference between the subgroups was significant (p=0.04).Aspirin at a daily dose of ≥100 mg for prevention of preeclampsia, initiated at ≤16 weeks of gestation rather than >16 weeks may decrease the risk of placental abruption or antepartum hemorrhage.