Low-dose aspirin for prevention of morbidity and mortality from preeclampsia: a systematic evidence review for the U.S. Preventive Services Task Force
- PMID: 24711050
- DOI: 10.7326/M13-2844
Low-dose aspirin for prevention of morbidity and mortality from preeclampsia: a systematic evidence review for the U.S. Preventive Services Task Force
Abstract
Background: Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality.
Purpose: To systematically review benefits and harms of low-dose aspirin for preventing morbidity and mortality from preeclampsia.
Data sources: MEDLINE, Database of Abstracts of Reviews of Effects, PubMed, and Cochrane Central Register of Controlled Trials (January 2006 to June 2013); previous systematic reviews, clinical trial registries, and surveillance searches for large studies (June 2013 to February 2014).
Study selection: Randomized, controlled trials (RCTs) to assess benefits among women at high preeclampsia risk and RCTs or large cohort studies of harms among women at any risk level. English-language studies of fair or good quality were included.
Data extraction: Dual quality assessment and abstraction of studies.
Data synthesis: Two large, multisite RCTs and 13 smaller RCTs of high-risk women (8 good-quality) were included, in addition to 6 RCTs and 2 observational studies of average-risk women to assess harms (7 good-quality). Depending on baseline risk, aspirin use was associated with absolute risk reductions of 2% to 5% for preeclampsia (relative risk [RR], 0.76 [95% CI, 0.62 to 0.95]), 1% to 5% for intrauterine growth restriction (RR, 0.80 [CI, 0.65 to 0.99]), and 2% to 4% for preterm birth (RR, 0.86 [CI, 0.76 to 0.98]). No significant perinatal or maternal harms were identified, but rare harms could not be ruled out. Evidence on long-term outcomes was sparse, but 18-month follow-up from the largest trial found no developmental harms.
Limitations: Benefits may have been overestimated due to small-study effects. Predictive intervals were not statistically significant. Future studies could shift findings toward the null.
Conclusion: Daily low-dose aspirin beginning as early as the second trimester prevented clinically important health outcomes. No harms were identified, but long-term evidence was limited.
Comment in
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Updated review identifies no adverse impact on mother or offspring during the perinatal period of aspirin use for prevention of preeclampsia.Evid Based Med. 2015 Feb;20(1):11. doi: 10.1136/ebmed-2014-110056. Epub 2014 Sep 19. Evid Based Med. 2015. PMID: 25238770 No abstract available.
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Low-dose aspirin for prevention of morbidity and mortality from preeclampsia.Ann Intern Med. 2014 Oct 21;161(8):613. doi: 10.7326/L14-5020-4. Ann Intern Med. 2014. PMID: 25329210 No abstract available.
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Low-dose aspirin for prevention of morbidity and mortality from preeclampsia.Ann Intern Med. 2014 Oct 21;161(8):613-4. doi: 10.7326/L14-5020-5. Ann Intern Med. 2014. PMID: 25329211 No abstract available.
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Low-dose aspirin reduces morbidity and mortality in pregnant women at high-risk for preeclampsia.Evid Based Nurs. 2015 Jul;18(3):71. doi: 10.1136/ebnurs-2014-101915. Epub 2015 Mar 5. Evid Based Nurs. 2015. PMID: 25743941 No abstract available.
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Another good reason to recommend low-dose aspirin.J Fam Pract. 2015 May;64(5):301-3. J Fam Pract. 2015. PMID: 26009747 Free PMC article.
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