孕期使用低剂量阿司匹林可能是产后出血和失血增加的潜在风险：一项系统评价和荟萃分析。

Low-dose asprin use during pregnancy may be a potential risk for postpartum hemorrhage and increased blood loss: a systematic review and meta-analysis.

作者信息

Jiang Yi, Chen Zhuoru, Chen Yuting, Wei Lijie, Gao Peng, Zhang Jingyi, Zhou Xuan, Zhu Shenglan, Zhang Huiting, Du Yuanyuan, Fang Chenyun, Su Rui, Wang Shaoshuai, Yu Jun, He Mengzhou, Ding Wencheng, Feng Ling

机构信息

Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (Dr Jiang, Dr Wei, Dr Gao, Dr Zhang, Dr Zhou, Dr Zhu, Dr H Zhang, Dr Du, Miss Fang, Miss Su, Dr Wang, Dr Yu, Dr He, Dr Ding, and Dr Feng).

Children's Hospital of Fudan University, Shanghai, China (Miss Chen).

出版信息

Am J Obstet Gynecol MFM. 2023 Apr;5(4):100878. doi: 10.1016/j.ajogmf.2023.100878. Epub 2023 Jan 25.

DOI:10.1016/j.ajogmf.2023.100878

PMID:36706919

Abstract

OBJECTIVE

The association between aspirin use during pregnancy and the risk of postpartum hemorrhage remains unclear. This study aimed to explore the incidence of postpartum hemorrhage and the amount of postpartum blood loss among women who used aspirin during pregnancy.

DATA SOURCES

From inception to October 2022, this study searched the following databases: MEDLINE, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials.

STUDY ELIGIBILITY CRITERIA

Studies comparing pregnancy outcomes that covered the incidence of postpartum hemorrhage or the amount of postpartum blood loss in pregnancies with aspirin vs placebo (or no aspirin) were included.

METHODS

Reviewers separately ascertained studies, obtained data, and gauged study quality. The meta-analysis was conducted using a random effects model owing to the probable heterogeneity of the included studies. The rates of postpartum hemorrhage or the mean amounts of postpartum blood loss were compared, and the odds ratios or mean differences with 95% confidence intervals were estimated. Of note, 2 parts performed both a pooled analysis of randomized controlled trials and cohort studies and a separate analysis of randomized controlled trials.

RESULTS

Overall, 21 studies with 373,926 women were included in the postpartum hemorrhage part, and 7 studies with 10,163 women were included in the postpartum blood loss part. The results suggested that aspirin (dose 60-150mg a day) use during pregnancy was associated with an increased incidence of postpartum hemorrhage (odds ratio, 1.20; 95% confidence interval, 1.07-1.34). When only randomized controlled trials were retained, the results remained significant (odds ratio, 1.12; 95% confidence interval, 1.00-1.25). In the second part, higher total blood loss after delivery was obtained (mean difference, 12.85 mL; 95% confidence interval, 3.28-22.42), and the result was unaltered when cohort studies were eliminated (mean difference, 13.72 mL; 95% confidence interval, 4.63-22.81). The conclusions are more likely to be obtained in developed countries.

CONCLUSION

Low-dose aspirin use during pregnancy is a potential risk of postpartum hemorrhage and does slightly increase the amount of postpartum blood loss. Without denying the combined value of aspirin, our conclusions raised an alarm for clinicians about postpartum hemorrhage in women using aspirin during pregnancy.

摘要

目的

孕期使用阿司匹林与产后出血风险之间的关联尚不清楚。本研究旨在探讨孕期使用阿司匹林的女性产后出血的发生率及产后失血量。

数据来源

从研究开始至2022年10月，本研究检索了以下数据库：医学期刊数据库（MEDLINE）、科学引文索引（Web of Science）、荷兰医学文摘数据库（Embase）以及考克兰系统评价数据库（Cochrane Central Register of Controlled Trials）。

研究纳入标准

纳入比较孕期使用阿司匹林与安慰剂（或不使用阿司匹林）的妊娠结局，涵盖产后出血发生率或产后失血量的研究。

方法

reviewers分别确定研究、获取数据并评估研究质量。由于纳入研究可能存在异质性，采用随机效应模型进行荟萃分析。比较产后出血率或产后平均失血量，并估计比值比或平均差值及95%置信区间。值得注意的是，有两部分分别对随机对照试验和队列研究进行了汇总分析以及对随机对照试验进行了单独分析。

结果

总体而言，产后出血部分纳入了21项研究，共373,926名女性；产后失血量部分纳入了7项研究，共10,163名女性。结果表明，孕期使用阿司匹林（每日剂量60 - 150毫克）与产后出血发生率增加相关（比值比为1.20；95%置信区间为1.07 - 1.34）。仅保留随机对照试验时，结果仍然显著（比值比为1.12；95%置信区间为1.00 - 1.25）。在第二部分中，分娩后总失血量更高（平均差值为12.85毫升；95%置信区间为3.28 - 22.42），排除队列研究后结果不变（平均差值为13.72毫升；95%置信区间为4.63 - 22.81）。这些结论在发达国家更有可能得出。