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Impact of low‐dose aspirin on adverse perinatal outcome: meta‐analysis and meta‐regression
Author(s) -
Turner J. M.,
Robertson N. T.,
Hartel G.,
Kumar S.
Publication year - 2020
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.20859
Subject(s) - medicine , meta analysis , gestational age , apgar score , placental abruption , low birth weight , relative risk , obstetrics , birth weight , subgroup analysis , neonatal intensive care unit , randomized controlled trial , pregnancy , gestation , pediatrics , confidence interval , genetics , biology
Objective To perform a meta‐analysis and meta‐regression of randomized controlled trials (RCTs) to evaluate the impact of low‐dose aspirin (LDA) on perinatal outcome, independent of its effect on pre‐eclampsia (PE), preterm birth and low birth weight. Methods An electronic search of EMBASE, PubMed, CENTRAL, PROSPERO and Google Scholar databases was performed to identify RCTs assessing the impact of LDA in pregnancy, published in English prior to May 2019, which reported perinatal outcomes of interest (placental abruption, delivery mode, low 5‐min Apgar score, neonatal acidosis, neonatal intensive care unit admission, periventricular hemorrhage and perinatal death). Risk ratios (RR) and 95% CI were calculated and pooled for analysis. Analysis was stratified according to gestational age at commencement of treatment (≤ 16 weeks vs > 16 weeks) and subgroup analysis was performed to assess the impact of aspirin dose (< 100 mg vs ≥ 100 mg). Meta‐regression was used to assess the impact of LDA on perinatal outcome, independent of the reduction in PE, preterm birth and low birth weight. Results Forty studies involving 34 807 participants were included. When LDA was commenced ≤ 16 weeks' gestation, it was associated with a significant reduction in the risk of perinatal death (RR, 0.47; 95% CI, 0.25–0.88; P = 0.02; number needed to treat, 92); however, this risk reduction was only seen when a daily dose of ≥ 100 mg was administered. If commenced > 16 weeks' gestation, LDA was associated with a significant reduction in 5‐min Apgar score < 7 (RR, 0.75; 95% CI, 0.58–0.96; P = 0.02) and periventricular hemorrhage (RR, 0.68; 95% CI, 0.47–0.99; P = 0.04), but a trend towards an increase in the risk of placental abruption (RR, 1.20; 95% CI, 1.00–1.46; P = 0.06) was also noted. LDA was not associated with any significant increase in adverse events if commenced ≤ 16 weeks gestation. LDA had no effect on delivery mode, irrespective of the gestational age at which it was started. Meta‐regression confirmed that the effect of LDA on perinatal death, when treatment was started ≤ 16 weeks' gestation, was independent of any reduction in the rate of PE and preterm birth. Conclusion LDA improves some important perinatal outcomes, without increasing adverse events such as placental abruption or periventricular hemorrhage, and its utility, if commenced prior to 16 weeks' gestation, may be considered in a wider context beyond the prevention of PE or fetal growth restriction. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.