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The role of aspirin dose and initiation time in the prevention of preeclampsia and corresponding complications: a meta-analysis of RCTs

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To investigate the role of different dosages and initial times of aspirin in preeclampsia prevention.

Methods

This meta-analysis was performed based on randomized-control trials (RCTs). RCTs of women assigned to receive low-dose aspirin, placebo, or no treatment were included. Preeclampsia and corresponding complications were pooled for analysis. All studies were retrieved from PubMed, Embase, Cochrane and Web of Science.

Results

A total of 46 studies were obtained in this meta-analysis, which consisted of 24,028 participants. When women at ≤ 16 gestational weeks started treatment with a dosage of < 100 mg/day aspirin, there was a significant reduction in the incidence of preeclampsia (RR = 0.75; 95% CI 0.58–0.98; P = 0.03), while in the subgroup receiving ≥ 100 mg/day aspirin, the result was RR = 0.71 (95% CI 0.53–0.95; P = 0.02). When aspirin was initiated at > 16 weeks, with a dosage of < 100 mg/day aspirin, there was a lesser preventive effect (RR = 0.80; 95% Cl 0.64–1.00; P = 0.05), and there was no significance in the subgroup receiving ≥ 100 mg/day aspirin (RR = 0.76; 95% Cl 0.45–1.31;  P =  0.32). Furthermore, aspirin was revealed to have a protective effect on reducing preterm delivery, but there was an increased risk of postpartum hemorrhage. No significant result was obtained for fetal loss.

Conclusion

The results of this meta-analysis suggest that high-risk pregnant women can prevent preeclampsia or preterm delivery by taking low-dose aspirin; the most efficient period is ≤ 16 weeks of gestation, and the best dose is ≥ 100 mg.

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Availability of data and materials

All original data included in this study are available in the corresponding articles.

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Author notes

  1. Ka Cheuk Yip, Ziyin Luo and Xiaman Huang contributed equally to this work.

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, First-Affiliated Hospital of Jinan University, Guangzhou, 510632, Guangdong, China

    Ka Cheuk Yip, Xiaman Huang, Chenyang Dai, Weiyu Zeng & Ruiman Li

  2. Faculty of Medicine, International School, Jinan University, Guangzhou, Guangdong, China

    Ziyin Luo, Weijen Lee & Layla Li

  3. Department of Sport Medicine, First-Affiliated Hospital of Jinan University, Guangzhou, 510632, Guangdong, China

    Tsz Ngai Mok

  4. Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China

    Qiyu He

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  1. Ka Cheuk Yip
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Contributions

All authors have read and approved the manuscript. The detailed contributions of each author are listed as follows: KCY, ZL and XH: protocol/project development; Data collection; data analysis; manuscript writing. WL: investigation. LL: language revising and polishing. CD: investigation. WZ: investigation. TNM: investigation. QH and RL: supervision, conceptualization, professional suggestion and revision.

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Correspondence to Qiyu He or Ruiman Li.

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Figure S1 Summary of each included study on risk of bias assessment (JPG 2342 kb)

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Yip, K.C., Luo, Z., Huang, X. et al. The role of aspirin dose and initiation time in the prevention of preeclampsia and corresponding complications: a meta-analysis of RCTs. Arch Gynecol Obstet 305, 1465–1479 (2022). https://doi.org/10.1007/s00404-021-06349-4

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