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Maternal and child health
Associations between the timing and dosing of aspirin prophylaxis and term and preterm pre-eclampsia
  1. Lisa Askie1,
  2. Lelia Duley2
  1. 1 NHMRC Clinical Trials Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
  2. 2 Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
  1. Correspondence to Professor Lisa Askie, NHMRC Clinical Trials Centre, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia; lisa.askie{at}ctc.usyd.edu.au

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Commentary on: Roberge S, Bujold E, Nicolaides KH. Aspirin for the prevention of pretermand term preeclampsia: systematic review and metaanalysis. Am J Obstet Gynecol 2018;218:287–93.

Context

Aspirin prophylaxis during pregnancy has been estimated in a participant-level meta-analysis to reduce the risk of pre-eclampsia by 10%.1 Evidence-based guidelines recommend aspirin for high-risk women, usually 75 mg from 12 weeks’ gestation and if possible before 20 weeks.2 Despite decades of research, controversy remains regarding the optimal dose and timing of aspirin treatment to prevent pre-eclampsia.

While a meta-analysis using individual participant data (IPD) concluded that the effect on pre-eclampsia is consistent regardless of whether treatment starts before or after 16 weeks,3 an aggregate data meta-analysis concluded that a lower dose of aspirin (<100 mg) started after 16 weeks has ‘modest or no impact’.4 Another recent IPD meta-analysis suggested a dose–response effect …

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