Prophylactic aspirin during pregnancy staves off pre-eclampsia risk

Among pregnant women, early initiation of low-dose aspirin largely reduces the incidence of pre-eclampsia and related neonatal outcomes without increasing the risk of bleeding, according to a meta-analysis.

Low-dose aspirin has been used as a preventive measure against pre-eclampsia, so researchers looked at existing literature to comprehensively investigate the maternal and neonatal outcomes related to the prophylactic use of aspirin during pregnancy by utilizing a stratification method.

The meta-analysis analysis included placebo-controlled randomized trials with sufficient raw data and published in English. Review articles, editorials, case reports, conference abstracts, and nonplacebo-controlled studies were excluded.

A total of 35 placebo-controlled randomized trials with 46,568 pregnant women met the inclusion criteria. Pooled data revealed that aspirin prophylaxis conferred a significant protection against the risk of pre-eclampsia, preterm birth, perinatal mortality, and intrauterine growth retardation. These benefits did not come with an elevated bleeding risk.

Of note, low-dose aspirin produced a meaningful improvement in neonatal birth weight but did not decrease the risk of gestational hypertension.

In a subgroup analysis, use of prophylactic low-dose aspirin conferred the said benefits (lower pre-eclampsia risk and enhanced birth weight and gestational age at delivery) among women who initiated treatment before 20 weeks of gestation (relative risk, 0.76, 95 percent confidence interval, 0.64–0.90; p=0.001).

However, low-dose aspirin exerted little effect on pregnancy outcomes. As such, further evaluation is required.