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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.

journal_name

Ann Intern Med

journal_title

Annals of internal medicine

authors

Henderson JT,Whitlock EP,O'Connor E,Senger CA,Thompson JH,Rowland MG

doi

10.7326/M13-2844

subject

Has Abstract

pub_date

2014-05-20 00:00:00

pages

695-703

issue

eissn

0003-4819

issn

1539-3704

pii

1859300

journal_volume

160

pub_type

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Low-dose aspirin for prevention of morbidity and mortality from preeclampsia: a systematic evidence review for the U.S. Preventive Services Task Force.