Department of Obstetric Medicine, Guy's and St. Thomas' NHS Foundation Trust and Imperial Healthcare NHS Trust, London, United Kingdom.
School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom.
Pharmacol Res. 2021 Jun;168:105547. doi: 10.1016/j.phrs.2021.105547. Epub 2021 Mar 12.
To systematically review contemporary data on the safety of clopidogrel and newer antiplatelet agents in pregnant women, with particular attention to maternal and neonatal complications.
The review protocol was published via PROSPERO (ID 42020165235) and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Databases were searched using MeSH and free text terms encompassing the included antiplatelets, relevant indications, and pregnancy. Included studies reported the drug dose, the stage of pregnancy at which it was administered, and at least one primary or secondary outcome relating to pregnancy. The primary outcome was reporting of complications associated with antiplatelet use in pregnancy.
The search yielded 5271 results. 39 publications were included, incorporating 42 live births. The mean age of women was 34.6 years. Seven different antiplatelet agents were described, clopidogrel being most frequent (n = 37). 14 women received antiplatelet therapy in the first trimester. 14 women had regional anaesthesia (12 while taking clopidogrel), all without complication. Two women developed bleeding post caesarean section. There were no recorded neonatal delivery complications. Two neonates had congenital anomalies not felt to be related to maternal antiplatelet use.
This systematic review describes outcomes for both mothers and neonates when exposed to clopidogrel at varying durations throughout gestation, and does not suggest higher than acceptable risk, with a congenital anomaly rate comparable to background risk. Evidence for other antiplatelet agents remains limited. Regional anaesthesia should be offered, with recommendation to stop prior to delivery in line with national guidance and in the context of individualised decision making.
系统回顾当代有关孕妇使用氯吡格雷和新型抗血小板药物安全性的数据，特别关注母体和新生儿并发症。
该综述方案通过 PROSPERO（ID 42020165235）发布，并按照系统评价和荟萃分析的首选报告项目（PRISMA）进行。使用包含纳入抗血小板药物、相关适应证和妊娠的 MeSH 和自由文本术语搜索数据库。纳入的研究报告了药物剂量、给药时的妊娠阶段以及至少一个与妊娠相关的主要或次要结局。主要结局是报告与妊娠期间使用抗血小板药物相关的并发症。
搜索结果为 5271 项。纳入 39 项研究，包含 42 例活产。女性的平均年龄为 34.6 岁。描述了 7 种不同的抗血小板药物，氯吡格雷最常见（n=37）。14 名妇女在孕早期接受抗血小板治疗。14 名妇女接受了区域麻醉（12 名同时服用氯吡格雷），均无并发症。两名妇女在剖宫产术后出现出血。无新生儿分娩并发症记录。两名新生儿存在先天性异常，但认为与母亲使用抗血小板药物无关。
本系统综述描述了在妊娠不同时期暴露于氯吡格雷的母亲和新生儿的结局，并未提示风险高于可接受水平，且先天性异常发生率与背景风险相当。其他抗血小板药物的证据仍然有限。应提供区域麻醉，并根据国家指南和个体化决策的背景建议在分娩前停药。
