Aspirin for the prevention of preeclampsia in women with abnormal uterine artery doppler: a meta-analysis1 ☆,
Section snippets
Data sources
Computerized searches were conducted using MEDLINE, Embase, and the Cochrane Controlled Trials Register to identify the maximum number of randomized trials published from 1966 to November 2000. A combination of medical subject headings and key words were used to generate two subsets of citations, one including studies of aspirin (“aspirin,” “antiplatelet∗,” “salicyl∗,” “acetylsalicyl∗,” and “platelet aggregation inhibitors”), and the other including studies of Doppler ultrasonography
Study selection
Studies were selected if the target population included women who had an abnormal uterine artery Doppler assessment in the second trimester. Any definition of abnormality was accepted; the therapeutic intervention was low-dose aspirin (any definition) compared with placebo or no drug treatment. The primary outcomes were proportion of women developing proteinuric hypertension (preeclampsia) and difference in birth weight. Secondary outcomes were nonproteinuric hypertension, small for gestational
Tabulation, integration, and results
The initial search yielded 332 articles, of which eight were judged to be possibly or definitely relevant (agreement 99.7%, κ 0.93). Four of these were excluded as three examined umbilical artery Doppler,22, 23, 24 and one evaluated the effect of aspirin on uteroplacental and fetal hemodynamics25 (agreement 100%, κ 1). Three further trials18, 26, 27 were identified from examining the reference lists of the identified articles. One article, by Hamid et al,27 was not used as it had been retracted
Conclusion
Our systematic review shows that low-dose aspirin treatment has a statistically significant effect in reducing the incidence of preeclampsia in women with abnormal uterine artery Doppler assessment diagnosed in the second trimester. Our review identifies a high-risk group in which the average number needed to treat with low-dose aspirin to prevent one case of preeclampsia is 16, making the screening and therapy with aspirin also clinically significant. However, the range of plausible number of
References (29)
- et al.
Thromboxane and prostacyclin in maternal and fetal circulation in pre-eclampsia
Int J Gynaecol Obstet
(1998) PreeclampsiaAn imbalance in placental prostacyclin and thromboxane production
Am J Obstet Gynecol
(1985)- et al.
A randomized controlled trial of aspirin in patients with abnormal uterine artery blood flow
Obstet Gynecol
(1996) - et al.
Beta blockade during and after myocardial infarctionAn overview of the randomized trials
Prog Cardiovasc Dis
(1985) - et al.
Doppler ultrasound and aspirin in recognition and prevention of pregnancy-induced hypertension
Lancet
(1990) - et al.
Effect of low-dose aspirin treatment on vascular resistance in the uterine, uteroplacental, renal and umbilical arteries—A prospective longitudinal study on a high risk population with persistent notch in the uterine arteries
Eur J Ultrasound
(1997) - et al.
Low-dose aspirin therapy improves fetal weight in umbilical placental insufficiency
Am J Obstet Gynecol
(1988) - Why mothers die. Report on confidential enquires into maternal deaths in the United Kingdom 1994–1996. The Stationary...
Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean
Br J Obstet Gynaecol
(1992)- Geographic variationin the incidence of hypertension in pregnancy. World Health Organization International...
How useful is uterine artery Doppler flow velocimetry in the prediction of pre-eclampsia, intrauterine growth retardation and perinatal death? An overview
Br J Obstet Gynaecol
Variation in baseline risk as an explanation of heterogeneity in meta-analysis
Stat Med
Prediction of pre-eclampsia by abnormal uterine Doppler ultrasound and modification by aspirin
Br J Obstet Gynaecol
Cited by (93)
Preeclampsia in high risk women is characterized by risk group-specific abnormalities in serum biomarkers
2014, American Journal of Obstetrics and GynecologyCitation Excerpt :Here we extend these findings to show that this difference arises primarily in the group with chronic hypertension. Although numerous studies and metaanalyses have shown a beneficial effect of LDA in specific populations of women,9-14 the results are far from uniform.2 Importantly, the MFMU High-Risk Aspirin trial of LDA to prevent preeclampsia in women at high risk of the disease based on chronic hypertension, insulin-dependent diabetes, multiple gestations, or a previous pregnancy complicated by preeclampsia showed no benefit of LDA.3
Effects of calcium, magnesium, low-dose aspirin and low-molecular-weight heparin on the release of PP13 from placental explants
2011, PlacentaCitation Excerpt :In the absence of primary prevention, research is directed towards methods of secondary prevention. The list of agents suggested as candidates for secondary prevention of preeclampsia is long and includes (among others) low-dose aspirin, low-molecular-weight heparin (LMWH), folic acid, antioxidants such as vitamins C and E, and calcium supplementation [2,4–15]. In clinical trials the effects of some of these drugs on the development of preeclampsia have already been investigated in pregnant women.
A Review of Roles of Uterine Artery Doppler in Pregnancy Complications
2022, Frontiers in MedicinePregnancy Complications, Correlation With Placental Pathology and Neonatal Outcomes
2021, Frontiers in Clinical Diabetes and HealthcareAntiplatelet agents for preventing pre-eclampsia and its complications
2019, Cochrane Database of Systematic Reviews
- ☆
No external funding was obtained for this study. All four authors are employees of the National Health Service, United Kingdom.
- 1
We thank Professor Stuart Campbell for providing additional study information.