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 One article, by Hamid et al,27 was not used as it had been retracted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
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Cited by (0)
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No external funding was obtained for this study. All four authors are employees of the National Health Service, United Kingdom.
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We thank Professor Stuart Campbell for providing additional study information.