ReviewAspirin for prevention of preeclampsia in women with historical risk factors: a systematic review☆
Section snippets
Sources
We searched MEDLINE (1966–2001), EMBASE (1980–2001), Cochrane Library (2001:3), National Research Register (2001:3), SCISEARCH (1974–2001), and conference proceedings (ISI Proceedings, 1990–2001) for relevant citations. A combination of medical subject headings and text 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 studies of preeclampsia
Study selection
Studies were selected if the target population was women with historical risk factors for preeclampsia, the therapeutic intervention was low-dose aspirin (any definition) compared with placebo or no drug treatment, and the studies were of randomized design. The historical risk factors included previous preeclampsia, chronic (preexisting) hypertension, diabetes, renal disease, and extremes of age at conception.3, 20, 21 The main outcomes were perinatal death and preeclampsia (proteinuric
Results
Figure 1 summarizes the process of literature identification and selection. Of the 729 citations identified, 47 were selected during the initial screening (agreement 99%; κ 0.91), and on examination of the full manuscripts of these 47, 12 articles,11, 12, 13, 14, 15, 17, 18, 19, 31, 32, 33, 34 and two abstracts (Azar R, Turpin D. Effect of antiplatelet therapy in women at high risk for pregnancy induced hypertension [abstract]. Proceedings of 7th World Congress, International Society for the
Conclusion
Our systematic review shows that low-dose aspirin has a significant effect in reducing the rates of a number of clinically relevant outcomes, including perinatal deaths and preeclampsia, in women with historical risk factors for preeclampsia.
The validity of our findings depends on the methodologic rigor of our review and of the component primary studies. We used a prospective protocol and made a concerted effort to find all the evidence. Two independent reviewers assessed study quality and
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All contributors to this review, except HH, are employees of the National Health Service of United Kingdom. HH holds a WellBeing Research Fund from the Royal College of Obstetricians and Gynaecologists (United Kingdom). No private or commercial funding was obtained.
AC and KSK conceived the review. AC, HH, and SP collected, analyzed, and interpreted the data and drafted the manuscript. KSK and HG made critical revisions. AC and HH are the guarantors for this article.