Abstract
Objective
To evaluate the association between the use of low-dose aspirin for preeclampsia prophylaxis
and risks of gestational diabetes (primary outcome), neonatal hypoglycemia, macrosomia,
large for gestational age, birth trauma, and shoulder dystocia (secondary outcomes).
Data Sources
We searched Ovid MEDLINE, Embase, CINAHL, and Cochrane/CENTRAL for studies published
between January 1, 1989, and April 24, 2021.
Study Selection
Randomized controlled trials (RCTs) or cohort studies of any size conducted in any
setting were included.
Data Extraction and Synthesis
We assessed risk of bias using the Cochrane Risk of Bias tool 2.0 (for RCTs) and the
Newcastle-Ottawa Scale (for cohort studies). We meta-analyzed relative risks (RRs)
using random-effects models.
Conclusions
Our search retrieved 4441 records, of which 9 studies (6 RCTs with 1932 patients and
3 cohort studies with 313 837 patients) met inclusion criteria. We rated only 4 of
the 6 RCTs and 1 of the 3 cohort studies at low risk of bias. Low-dose aspirin in
pregnancy for preeclampsia prophylaxis was not associated with a greater risk of gestational
diabetes (RR 1.18; 95% confidence interval 0.80–1.74). No studies reported data for
the secondary outcomes. In summary, the use of low-dose aspirin does not appear associated
with risk of gestational diabetes. The poor quality and small number of studies limit
the interpretation of these results.
Résumé
Objectif
Évaluer le lien entre la prophylaxie à faible dose d’aspirine en prévention de la
prééclampsie et les risques de diabète gestationnel (critère de jugement principal),
d’hypoglycémie néonatale, de macrosomie, d’hypertrophie, le traumatisme obstétrical
et la dystocie de l’épaule (critères de jugement secondaires).
Sources de données
Nous avons cherché des études publiées entre le 1er janvier 1989 et le 24 avril 2021 dans les bases de données Ovid Medline, Embase,
CINAHL et Cochrane Central Register of Controlled Trials.
Sélection des études
Les essais cliniques randomisés (ECR) et les études de cohortes de toutes tailles
menées dans n’importe quel contexte ont été inclus.
Extraction et synthèse des données
Nous avons évalué le risque de biais à l’aide de l’outil Cochrane Risk of Bias 2.0
(pour les ECR) et de l’échelle de Newcastle-Ottawa (pour les études de cohortes).
Nous avons effectué une méta-analyse des risques relatifs (RR) à l’aide de modèles
à effets aléatoires.
Conclusions
Notre recherche a permis de recenser 4 441 articles, desquels 9 études (6 ECR totalisant
1 932 patientes et 3 études de cohortes totalisant 313 837 patientes) répondaient
aux critères d’inclusion. Après l’évaluation du risque de biais, seulement 4 des 6
ECR et 1 des 3 études de cohortes se sont avérés à faible risque. La prophylaxie à
faible dose d’aspirine en prévention de la prééclampsie pendant la grossesse n’est
pas associée à une augmentation du risque de diabète gestationnel (RR : 1,18; intervalle
de confiance à 95 % : 0,80-1,74). Aucune étude n’a rapporté de données pour les critères
d’évaluation secondaires. En résumé, l’aspirine à faible dose ne semble pas associée
à un risque de diabète gestationnel. La faible qualité des études et leur petit nombre
limitent l’interprétation de ces résultats.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Obstetrics and Gynaecology CanadaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Trends in prevalence of diabetes among delivery hospitalizations, United States, 1993–2009.Matern Child Health J. 2014; 19: 635-642
- Shoulder dystocia: risk identification.Clin Obstet Gynecol. 2000; 43: 265-282
- Diabetes, fetal demise, and shoulder dystocia: the importance of glucose screening to prevent catastrophic obstetric outcomes.Case Rep Obstet Gynecol. 2020; 2020: 1-5
- Gestational diabetes mellitus and macrosomia: a literature review.Ann Nutr Metab. 2015; 66: 14-20
- Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: preeclampsia.Am J Obstet Gynecol. 2010; 202: 255.e1
- Growth hormone binding protein and maternal body mass index in relation to placental growth hormone and insulin requirements during pregnancy in type 1 diabetic women.Growth Horm IGF Res. 2005; 15: 223-230
- Relationship between elevated serum level of placental growth factor and status of gestational diabetes mellitus.J Matern Fetal Neonatal Med. 2020; 33: 4159-4163
- Low-dose aspirin use during pregnancy.(Available at:)https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/07/low-dose-aspirin-use-during-pregnancyDate accessed: August 21, 2021
- Suppression of thromboxane A2 but not of systemic prostacyclin by controlled-release aspirin.N Engl J Med. 1991; 325: 1137-1141
- Placental growth factor and pre-eclampsia.J Hum Hypertens. 2017; 31: 782
- Human placental lactogen in pre-eclampsia.Br J Obstet Gynaecol. 1984; 91: 1077-1080
- The effect of low-dose aspirin on serum placental growth factor levels in a high-risk PREDO cohort.Pregnancy Hypertens. 2018; 13: 51-57
- Impact of aspirin on fetal growth in diabetic pregnancies according to White classification.Am J Obstet Gynecol. 2017; 217: 465.e1-465.e5
- RoB 2: a revised tool for assessing risk of bias in randomised trials.BMJ. 2019; 366: l4898
- The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.(Available at:)http://www.ohri.ca/programs/clinical_epidemiology/oxford.aspDate accessed: January 28, 2022
- Role of aspirin in high pulsatility index of uterine artery: a consort study.J Obstet Gynaecol India. 2018; 68: 382-388
- Clinical characteristics of pregnant women on the use of daily low-dose aspirin in different hypertensive pregnancy disorders: a retrospective comparative study.J Pharm Bioallied Sci. 2019; 11: 83-95
- Aspirin use during pregnancy and the risk of bleeding complications: a Swedish population-based cohort study.Am J Obstet Gynecol. 2021; 224: 95.e1-95.e12
- Evaluation of the effect of metformin and aspirin on utero placental circulation of pregnant women with PCOS.Iran J Reprod Med. 2012; 10: 265
- Effect of early use of low-dose aspirin therapy on late-onset preeclampsia.J Matern Fetal Neonatal Med. 2019; 32: 2137-2142
- Maternal cardiac function in women at high risk for pre-eclampsia treated with 150 mg aspirin or placebo: an observational study.BJOG. 2020; 127: 1018-1025
- Preconception low-dose aspirin and pregnancy outcomes: results from the EAGeR randomised trial.Lancet. 2014; 384: 29-36
- Low-dose aspirin in prevention of miscarriage in women with unexplained or autoimmune related recurrent miscarriage: effect on prostacyclin and thromboxane A2 production.Hum Reprod. 1997; 12: 1567-1572
- Aspirin in the prevention of pre-eclampsia in high-risk women: a randomised placebo-controlled PREDO trial and a meta-analysis of randomised trials.BJOG. 2013; 120: 64-74
- Classification and diagnosis of diabetes.Diabetes Care. 2017; 40: S11-S24
- Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies.BMJ. 2016; 353: i1753
- Dose of aspirin to prevent preterm preeclampsia in women with moderate or high-risk factors: a systematic review and meta-analysis.PLOS One. 2021; 16e0247782
- Aspirin for the prevention of preterm and term preeclampsia: systematic review and metaanalysis.Am J Obstet Gynecol. 2018; 218: 287-293.e1
Article info
Publication history
Published online: May 27, 2022
Accepted:
May 6,
2022
Received:
April 23,
2022
Footnotes
Disclosures: The authors declare they have nothing to disclose.
All authors have indicated they meet the journal’s requirements for authorship.
Identification
Copyright
© 2022 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
