Department of Obstetrics and Gynecology, Klinikum Südstadt Rostock, Rostock University Hospital, Rostock, Germany; Department of Pharmacology and Toxicology, Rostock University Hospital, Rostock, Germany; Department of Obstetrics and Gynecology, Marienhaus Klinikum St. Elisabeth Neuwied.
Dtsch Arztebl Int. 2023 Sep 15;120(37):617-626. doi: 10.3238/arztebl.m2023.0133.
Recent studies suggest that low-dose acetylsalicylic acid (ASA) can lower pregnancy-associated morbidity.
This review is based on pertinent publications that were retrieved by a selective search in PubMed, with special attention to systematic reviews, metaanalyses, and randomized controlled trials.
Current meta-analyses document a reduction of the risk of the occurrence of pre-eclampsia (RR 0.85, NNT 50), as well as beneficial effects on the rates of preterm birth (RR 0.80, NNT 37), fetal growth restriction (RR 0.82, NNT 77), and perinatal death (RR 0.79, NNT 167). Moreover, there is evidence that ASA raises the rate of live births after a prior spontaneous abortion, while also lowering the rate of spontaneous preterm births (RR 0.89, NNT 67). The prerequisites for therapeutic success are an adequate ASA dose, early initiation of ASA, and the identification of women at risk of pregnancy-associated morbidity. Side effects of treatment with ASA in this patient group are rare and mainly involve bleeding in connection with the pregnancy (RR 0.87, NNH 200).
ASA use during pregnancy has benefits beyond reducing the risk of pre-eclampsia. The indications for taking ASA during pregnancy may be extended at some point in the future; at present, in view of the available evidence, it is still restricted to high-risk pregnancies.
最近的研究表明，低剂量乙酰水杨酸（ASA）可以降低与妊娠相关的发病率。
本综述基于在 PubMed 中进行选择性搜索获得的相关出版物，特别关注系统评价、荟萃分析和随机对照试验。
目前的荟萃分析证明，ASA 可以降低先兆子痫的发生风险（RR 0.85，NNH 50），并且对早产（RR 0.80，NNH 37）、胎儿生长受限（RR 0.82，NNH 77）和围产儿死亡（RR 0.79，NNH 167）的发生率也有有益影响。此外，有证据表明 ASA 可以提高既往自然流产后活产率，同时降低自发性早产率（RR 0.89，NNH 67）。治疗成功的前提是适当的 ASA 剂量、早期开始 ASA 治疗以及识别有妊娠相关发病率风险的女性。该患者群体中 ASA 治疗的副作用罕见，主要涉及与妊娠相关的出血（RR 0.87，NNH 200）。
ASA 在怀孕期间的使用除了降低先兆子痫的风险外还有益处。在未来的某个时候，ASA 在怀孕期间的使用指征可能会扩大；目前，鉴于现有证据，它仍然仅限于高危妊娠。
