Low-Dose Aspirin for the Prevention of Superimposed Preeclampsia in Women With Chronic Hypertension: A Systematic Review and Meta-analysis

IF 4.3 4区 医学 Q1 OBSTETRICS & GYNECOLOGY
Eleanor M. F. Richards, Veronica Giorgione, Oliver Stevens, Basky Thilaganathan
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引用次数: 1

Abstract

ABSTRACT Women with chronic hypertension are at increased risk for the development of preeclampsia during pregnancy. Low-dose aspirin treatment has been studied in the context of preeclampsia prevention, but there have been conflicting results among different populations. Some reasons for this are heterogeneous treatment regimens including timing, dosage, and even target outcomes. Among populations where there are limited data on the effect of low-dose aspirin on preeclampsia are women with chronic hypertension. This study is a systematic review and meta-analysis designed to analyze the use of low-dose aspirin during pregnancy and to assess whether the treatment reduces the risk of superimposed preeclampsia in women with chronic hypertension. It also aimed to secondarily assess related outcomes such as small for gestational age (SGA), preterm birth, and perinatal mortality. Systematic searches and assessment isolated 9 articles for final analysis. Six of these were randomized controlled trials, and 3 were retrospective cohort studies. Four studies focused on populations of only women with chronic hypertension, and the others included women with several different risk factors for preeclampsia. The retrospective studies and one of the randomized controlled trials compared aspirin treatment with no treatment, and the others compared with a placebo group; all studies used a dose of aspirin between 60 and 150 mg daily. No studies were excluded from the analysis based on risk of bias, as none were determined to be “critical” or “high” risk, although risk of bias was determined to be a contributing factor to low-quality data. Final analysis included a pooled sample size of 1078 individuals with chronic hypertension on low-dose aspirin, compared with 1072 women with chronic hypertension in control groups. This analysis did not find a decreased odds of superimposed preeclampsia in either randomized controlled trials (odds ratio [OR], 0.83; 95% confidence interval [CI], 0.55–1.25) or observational studies (OR, 1.21; 95% CI, 0.78–1.87). No significant differences were found with aspirin treatment, possibly due to risk of bias, heterogeneity, and imprecision. These findings held true when analyzed based on the timing of aspirin treatment induction (before or after 20 weeks' gestation), still finding no difference in the rate of superimposed preeclampsia. Low-dose aspirin treatment did reduce the odds of preterm birth according to a pooled analysis of 2 randomized controlled trials (OR, 0.62; 95% CI, 0.45–0.89). However, neither SGA nor perinatal mortality was shown to be significantly different in a pooled analysis of the studies that reported this outcome. Although these findings did not show statistical significance in reduction of preeclampsia in women with chronic hypertension due to aspirin treatment, the data are suggestive of benefit; many individuals in each study were lost to follow-up, and thus, the results of the analysis are different than they might have been with greater retention. The results from the observational studies show that low-dose aspirin treatment may statistically increase the likelihood of superimposed preeclampsia, but there is a high level of uncertainty associated with these results. They add to the conflicting findings previously present on this topic; more research is necessary with larger and less heterogeneous samples to clarify the association. The findings from this study contradict previous results in samples that include individuals with a variety of risk factors for preeclampsia, but they are consistent with previous research including only individuals with chronic hypertension. This study was limited by the quality of evidence due to heterogeneity and bias but should prompt further research regarding low-dose aspirin treatment in populations with chronic hypertension.
低剂量阿司匹林预防慢性高血压女性合并子痫前期:一项系统综述和荟萃分析
患有慢性高血压的女性在怀孕期间发生子痫前期的风险增加。低剂量阿司匹林治疗已经在预防子痫前期的背景下进行了研究,但在不同的人群中有相互矛盾的结果。造成这种情况的一些原因是治疗方案的不均匀,包括时间、剂量,甚至目标结果。在低剂量阿司匹林对子痫前期影响的数据有限的人群中,有慢性高血压的妇女。本研究是一项系统综述和荟萃分析,旨在分析妊娠期间低剂量阿司匹林的使用情况,并评估该治疗是否能降低慢性高血压妇女合并先兆子痫的风险。它还旨在次要评估相关结果,如小于胎龄(SGA)、早产和围产期死亡率。系统检索和评估分离出9篇文章进行最终分析。其中6项为随机对照试验,3项为回顾性队列研究。四项研究只关注患有慢性高血压的女性人群,其他研究包括患有子痫前期几种不同风险因素的女性。回顾性研究和一项随机对照试验将阿司匹林治疗组与不治疗组进行了比较,其他研究将安慰剂组与安慰剂组进行了比较;所有研究使用的阿司匹林剂量在每天60到150毫克之间。没有研究被排除在基于偏倚风险的分析之外,因为没有研究被确定为“关键”或“高”风险,尽管偏倚风险被确定为低质量数据的一个促成因素。最终分析包括1078名服用低剂量阿司匹林的慢性高血压患者,与对照组的1072名女性慢性高血压患者进行比较。该分析未发现两项随机对照试验中合并先兆子痫的几率降低(比值比[OR], 0.83;95%可信区间[CI], 0.55-1.25)或观察性研究(or, 1.21;95% ci, 0.78-1.87)。阿司匹林治疗组未发现显著差异,可能是由于存在偏倚、异质性和不精确的风险。当基于阿司匹林治疗诱导的时间(妊娠20周之前或之后)进行分析时,这些发现是正确的,仍然没有发现叠加先兆子痫发生率的差异。根据两项随机对照试验的汇总分析,低剂量阿司匹林治疗确实降低了早产的几率(OR, 0.62;95% ci, 0.45-0.89)。然而,在对报道这一结果的研究的汇总分析中,SGA和围产期死亡率均未显示出显著差异。虽然这些发现在阿司匹林治疗导致的慢性高血压妇女子痫前期减少方面没有统计学意义,但这些数据表明是有益的;每项研究中都有许多个体在随访中丢失,因此,分析的结果与保留更大的情况下可能出现的结果不同。观察性研究的结果表明,低剂量阿司匹林治疗可能在统计学上增加合并先兆子痫的可能性,但这些结果存在高度的不确定性。它们增加了先前关于这一主题的相互矛盾的发现;需要更多的研究,以更大和更少的异质样本来澄清这种联系。这项研究的结果与之前的研究结果相矛盾,之前的研究包括了具有各种子痫前期风险因素的个体,但与之前的研究一致,仅包括慢性高血压患者。由于异质性和偏倚,本研究受到证据质量的限制,但应促进对慢性高血压人群低剂量阿司匹林治疗的进一步研究。
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来源期刊
CiteScore
2.70
自引率
3.20%
发文量
245
审稿时长
>12 weeks
期刊介绍: ​Each monthly issue of Obstetrical & Gynecological Survey presents summaries of the most timely and clinically relevant research being published worldwide. These concise, easy-to-read summaries provide expert insight into how to apply the latest research to patient care. The accompanying editorial commentary puts the studies into perspective and supplies authoritative guidance. The result is a valuable, time-saving resource for busy clinicians.
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