NHMRC Clinical Trials Centre, University of Sydney, Camperdown NSW, and the Robinson Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia; and the Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, and the Department of Obstetrics and Gynecology, Amsterdam Medical Centre, Amsterdam, the Netherlands.
Obstet Gynecol. 2017 Feb;129(2):327-336. doi: 10.1097/AOG.0000000000001848.
Spontaneous preterm birth is an important cause of neonatal mortality and morbidity. An increasing body of evidence suggests that uteroplacental ischemia plays an important role in the etiology of spontaneous preterm birth. We aimed to study whether antiplatelet agents reduce the risk of spontaneous preterm birth.
We included data from an individual participant data meta-analysis of studies that had evaluated the effect of antiplatelet agents to reduce preeclampsia (Perinatal Antiplatelet Review of International Studies Individual Participant Data).
The meta-analysis included 31 studies that randomized women to low-dose aspirin-dipyridamole or placebo-no treatment as a primary preventive strategy for preeclampsia. For the current study we analyzed data from 17 trials (28,797 women) that supplied data on type of delivery (spontaneous compared with indicated birth).
TABULATION, INTEGRATION, AND RESULTS: Primary endpoints were spontaneous preterm birth at less than 37 weeks, less than 34 weeks, and less than 28 weeks of gestation. We analyzed outcomes for each trial separately using χ statistics and combined in an individual participant data meta-analysis using a binary logistic regression model. Women assigned to antiplatelet treatment compared with placebo or no treatment had a lower risk of spontaneous preterm birth at less than 37 weeks (relative risk [RR] 0.93, 95% confidence interval [CI] 0.86-0.996) and less than 34 weeks of gestation (RR 0.86, 95% CI 0.76-0.99). The RR of having a spontaneous preterm birth at less than 37 weeks of gestation was 0.83 (95% CI 0.73-0.95) for women who have had a previous pregnancy and 0.98 (95% CI 0.89-1.09) for women in their first pregnancy. The treatment effect was stable in all other prespecified subgroups.
Antiplatelet agents reduce spontaneous preterm birth in pregnant women at risk for preeclampsia.
自发性早产是新生儿死亡和发病的一个重要原因。越来越多的证据表明，胎盘缺血在自发性早产的病因学中起着重要作用。我们旨在研究抗血小板药物是否降低自发性早产的风险。
我们纳入了一项个体参与者数据荟萃分析的研究数据，该分析评估了抗血小板药物降低子痫前期风险的效果（围产期抗血小板药物国际研究个体参与者数据综述）。
该荟萃分析纳入了 31 项随机分配妇女接受低剂量阿司匹林-双嘧达莫或安慰剂-不治疗作为子痫前期一级预防策略的研究。在当前研究中，我们分析了 17 项试验（28797 名妇女）的数据，这些试验提供了分娩类型（自发性与指示性分娩）的数据。
列表、整合和结果：主要终点是小于 37 周、小于 34 周和小于 28 周的自发性早产。我们使用 χ 统计数据分别分析每个试验的结果，并使用二元逻辑回归模型在个体参与者数据荟萃分析中进行组合。与安慰剂或不治疗相比，接受抗血小板治疗的妇女自发性早产的风险较低，不到 37 周（相对风险 [RR] 0.93，95%置信区间 [CI] 0.86-0.996）和不到 34 周（RR 0.86，95% CI 0.76-0.99）。曾有过妊娠的妇女自发性早产不到 37 周的 RR 为 0.83（95% CI 0.73-0.95），初产妇的 RR 为 0.98（95% CI 0.89-1.09）。在所有其他预先指定的亚组中，治疗效果均稳定。
抗血小板药物可降低子痫前期高危孕妇的自发性早产。
