Askie Lisa M, Duley Lelia, Henderson-Smart David J, Stewart Lesley A
Centre for Perinatal Health Services Research, University of Sydney, Sydney, Australia; NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia; UK Cochrane Centre, Oxford, UK.
Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Lancet. 2007 May 26;369(9575):1791-1798. doi: 10.1016/S0140-6736(07)60712-0.
Pre-eclampsia is a major cause of mortality and morbidity during pregnancy and childbirth. Antiplatelet agents, especially low-dose aspirin, might prevent or delay pre-eclampsia, and thereby improve outcome. Our aim was to assess the use of antiplatelet agents for the primary prevention of pre-eclampsia, and to explore which women are likely to benefit most.
We did a meta-analysis of individual patient data from 32,217 women, and their 32,819 babies, recruited to 31 randomised trials of pre-eclampsia primary prevention.
For women assigned to receive antiplatelet agents rather than control, the relative risk of developing pre-eclampsia was 0.90 (95% CI 0.84-0.97), of delivering before 34 weeks was 0.90 (0.83-0.98), and of having a pregnancy with a serious adverse outcome was 0.90 (0.85-0.96). Antiplatelet agents had no significant effect on the risk of death of the fetus or baby, having a small for gestational age infant, or bleeding events for either the women or their babies. No particular subgroup of women was substantially more or less likely to benefit from antiplatelet agents than any other.
Antiplatelet agents during pregnancy are associated with moderate but consistent reductions in the relative risk of pre-eclampsia, of birth before 34 weeks' gestation, and of having a pregnancy with a serious adverse outcome.
子痫前期是妊娠和分娩期间死亡和发病的主要原因。抗血小板药物，尤其是低剂量阿司匹林，可能预防或延缓子痫前期，从而改善结局。我们的目的是评估抗血小板药物用于子痫前期一级预防的情况，并探讨哪些女性可能获益最大。
我们对来自31项子痫前期一级预防随机试验的32217名女性及其32819名婴儿的个体患者数据进行了荟萃分析。
对于被分配接受抗血小板药物而非对照的女性，发生子痫前期的相对风险为0.90（95%CI 0.84-0.97），在34周前分娩的相对风险为0.90（0.83-0.98），妊娠出现严重不良结局的相对风险为0.90（0.85-0.96）。抗血小板药物对胎儿或婴儿死亡风险、小于胎龄儿风险或女性及其婴儿的出血事件风险无显著影响。没有哪一特定亚组女性比其他女性从抗血小板药物中获益更多或更少。
孕期使用抗血小板药物与子痫前期、妊娠34周前分娩以及妊娠出现严重不良结局的相对风险适度但持续降低相关。
