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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.
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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