■通过对安慰剂对照随机对照试验(RCT)的荟萃分析,评估低剂量阿司匹林(LDA)对产科结局的影响。
■对PubMed的系统搜索,科克伦图书馆,从开始到2024年1月,进行了WebofScience和Embase数据库,以确定探索阿司匹林对怀孕的作用的研究。报告产科相关结果,包括早产(PTB,胎龄<37周),小于胎龄(SGA),低出生体重(LBW,出生体重<2500g),围产期死亡(PND),入院新生儿重症监护病房(NICU),5分钟Apgar评分<7,胎盘早剥。估计综合结果的相对风险(RR)。亚组分析按先兆子痫(PE)风险进行,LDA剂量(<100mgvs.≥100毫克)和发病时间(≤20周vs.>20周)。
■纳入了47项研究,涉及59,124名参与者。与安慰剂相比,LDA对SGA等低风险事件有更显著的影响,PTB和LBW。具体来说,LDA显著降低SGA的风险(RR=0.91,95%CI:0.87-0.95),PTB(RR=0.93,95%CI:0.89-0.97)和LBW(RR=0.94,95%CI:0.89-0.99)。对于高风险事件,LDA显著降低NICU入院风险(RR=0.93,95%CI:0.87-0.99)。另一方面,LDA可显著增加胎盘早剥风险(RR=1.72,95%CI:1.23~2.43)。亚组分析显示,LDA显着降低SGA的风险(RR=0.86,95%CI:0.77-0.97),PE高危孕妇的PTB(RR=0.93,95%CI:0.88-0.98)和PND(RR=0.65,95%CI:0.48-0.88),而在健康孕妇中,LDA并未显着改善产科结局,但却显著增加了胎盘早剥的风险(RR=5.56,95%CI:1.92-16.11)。在高危PE的孕妇中,剂量≥100mg的LDA显着降低了SGA(RR=0.77,95%CI:0.66-0.91)和PTB(RR=0.56,95%CI:0.32-0.97)的风险,但对降低NICU的风险没有统计学意义,PND和LBW。LDA在≤20周时开始显着降低SGA(RR=0.76,95%CI:0.65-0.89)和PTB(RR=0.56,95%CI:0.32-0.97)的风险。
■总而言之,LDA明显改善PE高危孕妇的新生儿结局,而不增加胎盘早剥的风险。这些发现支持LDA在孕妇中的临床应用,尽管需要进一步的研究来完善剂量和时机建议.
UNASSIGNED: To assess the impact of low-dose aspirin (LDA) on obstetrical outcomes through a meta-analysis of placebo-controlled randomized controlled trials (RCTs).
UNASSIGNED: 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 <37 weeks), small for gestational age (SGA), low birth weight (LBW, birthweight < 2500g), perinatal death (PND), admission to the neonatal intensive care unit (NICU), 5-min Apgar score < 7 and placental abruption. Relative risks (RRs) were estimated for the combined outcomes. Subgroup analyses were performed by risk for preeclampsia (PE), LDA dosage (<100 mg vs. ≥100 mg) and timing of onset (≤20 weeks vs. >20 weeks).
UNASSIGNED: 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).
UNASSIGNED: 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.