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Association Between Low-Dose Aspirin and Development of Gestational Diabetes: A Systematic Review and Meta-Analysis

      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

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