Richards Eleanor M F, Giorgione Veronica, Stevens Oliver, Thilaganathan Basky
Department of Obstetrics and Gynaecology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
Molecular and Clinical Sciences Research Institute, St. George's University of London, London, United Kingdom; Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom.
Am J Obstet Gynecol. 2023 Apr;228(4):395-408. doi: 10.1016/j.ajog.2022.09.046. Epub 2022 Oct 7.
This systematic review and meta-analysis investigated whether the use of low-dose aspirin during pregnancy by women with chronic hypertension reduces the odds of superimposed preeclampsia and poor perinatal outcomes.
In September 2021, the following sources were searched: Embase, MEDLINE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and EU Clinical Trials Register. Only human studies were included, with no time or language restrictions.
Cohort, case-control, and randomized controlled studies reporting women with chronic hypertension pregnant with a singleton were included. Eligible studies compared low-dose aspirin use during pregnancy with a control arm.
Risk of bias was assessed using the RoB 2 and ROBINS-I tools. A meta-analysis was performed using a random-effects model, estimating odds ratios and 95% confidence and prediction intervals, and the quality of data was assessed with the GRADE approach. Heterogeneity was investigated in regard to study methodology, timing of commencement of aspirin, and the outcome of preterm preeclampsia.
Nine studies (3 retrospective cohort studies and 6 randomized trials) including 2150 women with chronic hypertension were included. Low-dose aspirin prophylaxis did not significantly reduce the odds of superimposed preeclampsia in the randomized controlled trials (odds ratio, 0.83; 95% confidence interval, 0.55-1.25; prediction interval, 0.27-2.56; low-quality evidence) or observational studies (odds ratio, 1.21; 95% confidence interval, 0.78-1.87; prediction interval, 0.07-20.80; very low-quality evidence). Low-dose aspirin also did not reduce the odds of preterm preeclampsia (odds ratio, 1.17; 95% confidence interval, 0.74-1.86), and early aspirin initiation had no significant impact. There was no significant effect on small-for-gestational-age neonates or perinatal mortality; however, there was a significant reduction in preterm birth (odds ratio, 0.63; 95% confidence interval, 0.45-0.89; moderate-quality evidence). The quality of the evidence is limited by heterogeneity and risk of bias.
This meta-analysis was unable to demonstrate a significant change in the odds of superimposed preeclampsia, small-for-gestational-age infants, or perinatal mortality with the use of low-dose aspirin in women with chronic hypertension. However, significant reduction in preterm birth justifies the continued use of aspirin prophylaxis. This work was prospectively registered on the International Prospective Register of Systematic Reviews (registration number CRD42021285921).
本系统评价和荟萃分析旨在研究慢性高血压女性孕期使用小剂量阿司匹林是否能降低并发子痫前期及不良围产期结局的几率。
2021年9月，检索了以下来源：Embase、MEDLINE、Cochrane对照试验中心注册库、ClinicalTrials.gov、世界卫生组织国际临床试验注册平台和欧盟临床试验注册库。仅纳入人体研究，无时间或语言限制。
纳入报告慢性高血压女性单胎妊娠的队列研究、病例对照研究和随机对照研究。符合条件的研究将孕期使用小剂量阿司匹林与对照组进行比较。
使用RoB 2和ROBINS-I工具评估偏倚风险。采用随机效应模型进行荟萃分析，估计比值比及95%置信区间和预测区间，并采用GRADE方法评估数据质量。针对研究方法、阿司匹林开始使用时间以及早发型子痫前期结局调查了异质性。
纳入9项研究（3项回顾性队列研究和6项随机试验），共2150名慢性高血压女性。在随机对照试验中，小剂量阿司匹林预防并未显著降低并发子痫前期的几率（比值比为0.83；95%置信区间为0.55 - 1.25；预测区间为0.27 - 2.56；低质量证据），观察性研究中也是如此（比值比为1.21；95%置信区间为0.78 - 1.87；预测区间为0.07 - 20.80；极低质量证据）。小剂量阿司匹林也未降低早发型子痫前期的几率（比值比为1.17；95%置信区间为0.74 - 1.86），早期开始使用阿司匹林也无显著影响。对小于胎龄儿或围产期死亡率无显著影响；然而，早产几率显著降低（比值比为0.63；95%置信区间为0.45 - 0.89；中等质量证据）。证据质量受异质性和偏倚风险限制。
本荟萃分析未能证明慢性高血压女性使用小剂量阿司匹林会使并发子痫前期、小于胎龄儿或围产期死亡率的几率发生显著变化。然而，早产几率显著降低证明继续使用阿司匹林预防是合理的。本研究已在国际系统评价前瞻性注册库前瞻性注册（注册号CRD42021285921）。
