Effectiveness of Aspirin Dose in Preventing Preeclampsia in High-Risk Group: A Meta-Analysis

Tigor Peniel Simanjuntak; Elena Elena; Batara Imanuel Sirait

doi:10.24198/obgynia.v8i2.848

Effectiveness of Aspirin Dose in Preventing Preeclampsia in High-Risk Group: A Meta-Analysis

Tigor Peniel Simanjuntak, Elena Elena, Batara Imanuel Sirait

Abstract

Introduction: Preeclampsia is hypertension that occurs after 20 weeks of pregnancy and is accompanied by impaired function of the mother’s organs or the uteroplacental unit.
Purpose: To evaluate the efficacy of aspirin doses in preventing preeclampsia in high-risk populations.
Method: This study follows the PRISMA protocol. The reviewers examined all the findings and selected studies that met the inclusion criteria and PICO analysis. Statistical analysis was performed using Review Manager 5.4 software. A total of 14 journals met the inclusion criteria with searches in four databases (PubMed, Science Direct, Google Scholar, and Plos One).
Result: Aspirin significantly reduced the incidence of preeclampsia in the high-risk group (RR 0.83 [95% CI: 0.78, 0.88], P<0.00001), reducing the incidence of preeclampsia by 50 mg/day (RR 0.56 [95% CI: 0.36, 0.86] P=0.008), 60 mg/day (RR 0.87 [95% CI: 0.81, 0.93] P <0.0001), 75 mg/day (RR 0.54 [95% CI: 0.40, 0.73] P<0.0001), 80-81 mg/day (RR 0.72 [95% CI: 0.56, 0.94] P=0.02), and 150 mg/day, reduced the incidence of PE (P<0.00001).
Conclusion: The results of the study show that the best dose of aspirin to prevent PE in high-risk groups is 75 mg/day.

Efektivitas Dosis Aspirin untuk Mencegah Preeklamsia pada Kelompok Risiko Tinggi: Sebuah Metaanalisis

Abstrak
Pendahuluan: Preeklamsia adalah hipertensi yang terjadi setelah usia kehamilan 20 minggu dan disertai dengan gangguan fungsi organ ibu atau uteroplasenta.
Tujuan: Untuk mengetahui efektivitas dosis aspirin untuk mencegah preeklamsia pada kelompok risiko tinggi.
Metode: Penelitian ini mengikuti protokol PRISMA. Para peninjau memeriksa semua temuan dan memilih penelitian yang memenuhi kriteria inklusi dan analisis PICO. Analisis statistik dilakukan dengan menggunakan perangkat lunak Review Manager 5.4. Terdapat 14 jurnal yang memenuhi kriteria inklusi dengan pencarian di 4 database (PubMed, Science Direct, Google Scholar, dan Plos One).
Hasil: Aspirin secara signifikan menurunkan kejadian preeklampsia pada kelompok risiko tinggi (RR 0,83 [95% CI: 0,78, 0,88], P<0,00001), menurunkan kejadian preeklamsia sebesar 50 mg/hari (RR 0.56 [95% CI: 0.36, 0.86] P=0.008), 60 mg/hari (RR 0.87 [95% CI: 0,81, 0.93] P <0,0001), 75 mg/hari (RR 0,54 [95% CI: 0,40, 0,73] P<0,0001), 80-81 mg/hari (RR 0,72 [95% CI: 0,56, 0,94] P=0,02), dan 150 mg/hari, mengurangi kejadian PE (P<0,00001).
Kesimpulan: Hasil penelitian menunjukan bahwa dosis aspirin terbaik untuk mencegah PE pada kelompok risiko tinggi adalah 75 mg/hari.

Keywords

aspirin; dose; effectiveness; pre-eclampsia; prevention.

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References

Cunningham FG, Leveno KJ, Dashe JS, Hoffman BL, Spong CY, Casey BM. Williams Obstetrics. 26 th. New York: McGraw-Hill Education/Medical; 2022. 728–769 p.

Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al. The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens [Internet]. 2018;13:291–310. Available from: https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.117.10803

Bar J, Hod M, Pardo J, Fisch B, Rabinerson D, Kaplan B, et al. Effect on fetal circulation of low-dose aspirin for prevention and treatment of pre-eclampsia and intrauterine growth restriction: Doppler flow study. Ultrasound Obs Gynecol.bstet Gynecol [Internet]. 1997;9:262–5. Available from: https://obgyn.onlinelibrary.wiley.com/doi/10.1046/j.1469-0705.1997.09040262.x

Caritis SN, Hospital M womens, Sibai BM, Klebanoff MA, Thom E. Low-Dose Aspirin to Prevent Preeclampsia in Women at High Risk. N Engl J Med. 1998;338(11):701–5.

Grab D, Paulus WE, Erdmann M, Terinde R, Oberhoffer R, Lang D, et al. Effects of low-dose aspirin on uterine and fetal blood flow during pregnancy: results of a randomized, placebo-controlled, double-blind trial. Ultrasound Obstet Gynecol. 2000;15(1):19–27.

Moore GS, Allshouse AA, Post AL, Galan HL, Heyborne KD. Early initiation of low-dose aspirin for reduction in preeclampsia risk in high-risk women: A secondary analysis of the MFMU High-Risk Aspirin Study. J Perinatol [Internet]. 2015;35(5):328–31. Available from: https://www.nature.com/articles/jp2014214

Odibo AO, Goetzinger KR, Odibo L, Tuuli MG. Early prediction and aspirin for prevention of pre-eclampsia ( EPAPP ) study : a randomized controlled trial. Ultra Obs Gynecol. 2015;46:414–8.

Liu F, Zhao M, Wang M, Yang H, Li L. Effect of regular oral intake of aspirin during pregnancy on pregnancy outcome of high-risk pregnancy-induced hypertension syndrome patients. Eur Rev Med Pharmacol Sci [Internet]. 2016;20(23):5013–6. Available from: https://pubmed.ncbi.nlm.nih.gov/27981529/

Rolnik DL, Wright D, Poon LC, O’Gorman N, Syngelaki A, Matallana C de P, et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med. 2017;388(8):613–22.

Hauspurg A, Sutton EF, Catov JM, Caritis SN. Aspirin Effect on Adverse Pregnancy Outcomes Associated With Stage 1 Hypertension in a High-Risk Cohort. Hypertension. 2018;72(1):202–7.

Tolcher MC, Sangi-haghpeykar H, Mendez-figueroa H, Aagaard KM. Low-dose aspirin for preeclampsia prevention: efficacy by ethnicity and race. Am J Obstet Gynecol MFM [Internet]. 2020;2(4):100184. Available from: https://doi.org/10.1016/j.ajogmf.2020.100184

Abdi N, Rozrokh A, Alavi A, Zare S, Vafaei H, Asadi N. The effect of aspirin on preeclampsia , intrauterine growth restriction and preterm delivery among healthy pregnancies with a history of preeclampsia. J Chin Med Assoc. 2020;83:852–7.

Gu W, Lin J, Hou YY, Lin N, Song MF, Zeng WJ, et al. Effects of low-dose aspirin on the prevention of preeclampsia and pregnancy outcomes: A randomized controlled trial from Shanghai, China. Eur J Obstet Gynecol Reprod Biol. 2020;248(910):156–63.

Huai J, Lin L, Juan J, Chen J, Li B, Zhu Y, et al. Preventive effect of aspirin on preeclampsia in high-risk pregnant women with stage 1 hypertension. J Clin Hypertens. 2021;23:1060–7.

Lin L, Huai J, Li B, Zhu Y, Juan J, Zhang M, et al. A randomized controlled trial of low-dose aspirin for the prevention of preeclampsia in women at high risk in China. Am J Obstet Gynecol [Internet]. 2022;226(2):251.e1-12. Available from: https://www.ajog.org/article/S0002-9378(21)00869-3/pdf

Rana S, Lemoine E, Granger J, Karumanchi SA. Preeclampsia: Pathophysiology, Challenges, and Perspectives. Circ Res. 2019;124(7):1094–112.

DOI: http://dx.doi.org/10.24198/obgynia.v8i2.848