Journal of Psychosomatic Obstetrics and Gynecology (Dec 2024)

Impact of low-dose aspirin exposure on obstetrical outcomes: a meta-analysis

  • Xiaoyan Lin,
  • Jingchao Yong,
  • Ming Gan,
  • Shaowen Tang,
  • Jiangbo Du

DOI
https://doi.org/10.1080/0167482X.2024.2344079
Journal volume & issue
Vol. 45, no. 1

Abstract

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AbstractObjective To assess the impact of low-dose aspirin (LDA) on obstetrical outcomes through a meta-analysis of placebo-controlled randomized controlled trials (RCTs).Methods A systematic search of the PubMed, Cochrane Library, Web of Science and Embase databases from inception to January 2024 was conducted to identify studies exploring the role of aspirin on pregnancy, reporting obstetrical-related outcomes, including preterm birth (PTB, gestational age 20 weeks).Results Forty-seven studies involving 59,124 participants were included. Compared with placebo, LDA had a more significant effect on low-risk events such as SGA, PTB and LBW. Specifically, LDA significantly reduced the risk of SGA (RR = 0.91, 95% CI: 0.87–0.95), PTB (RR = 0.93, 95% CI: 0.89–0.97) and LBW (RR = 0.94, 95% CI: 0.89–0.99). For high-risk events, LDA significantly lowered the risk of NICU admission (RR = 0.93, 95% CI: 0.87–0.99). On the other hand, LDA can significantly increase the risk of placental abruption (RR = 1.72, 95% CI: 1.23–2.43). Subgroup analyses showed that LDA significantly reduced the risk of SGA (RR = 0.86, 95% CI: 0.77–0.97), PTB (RR = 0.93, 95% CI: 0.88–0.98) and PND (RR = 0.65, 95% CI: 0.48–0.88) in pregnant women at high risk of PE, whereas in healthy pregnant women LDA did not significantly improve obstetrical outcomes, but instead significantly increased the risk of placental abruption (RR = 5.56, 95% CI: 1.92–16.11). In pregnant women at high risk of PE, LDA administered at doses ≥100 mg significantly reduced the risk of SGA (RR = 0.77, 95% CI: 0.66–0.91) and PTB (RR = 0.56, 95% CI: 0.32–0.97), but did not have a statistically significant effect on reducing the risk of NICU, PND and LBW. LDA started at ≤20 weeks significantly reduced the risk of SGA (RR = 0.76, 95% CI: 0.65–0.89) and PTB (RR = 0.56, 95% CI: 0.32–0.97).Conclusions To sum up, LDA significantly improved neonatal outcomes in pregnant women at high risk of PE without elevating the risk of placental abruption. These findings support LDA’s clinical application in pregnant women, although further research is needed to refine dosage and timing recommendations.

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