The following is a summary of “Low-dose Aspirin for the Prevention of Preterm Birth in Nulliparous Women: Systematic Review and Meta-analysis,” published in the April 2024 issue of Obstetrics and Gynaecology by Yan et al.

This study aimed to comprehensively evaluate the efficacy and safety of low-dose aspirin in preventing preterm birth among nulliparous women.

Researchers systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to June 2022.

Randomized controlled trials comparing aspirin to placebo in nulliparous women were eligible for inclusion.

Investigators adhered to the PRISMA 2020 checklist when reporting this study. Primary outcomes included rates of preterm birth at less than 37 weeks and less than 34 weeks of gestation. Secondary outcomes comprised postpartum hemorrhage, placental abruption, cesarean section, hypertensive disorders of pregnancy, and small for gestational age. Relative risks (RR) with 95% CIs were calculated, and heterogeneity was assessed using Cochran’s Q test and Higgins’s I² statistic. Sensitivity analysis was performed to confirm the robustness of the findings.

Seven studies involving 29,029 participants were included. Low-dose aspirin was associated with a significant reduction in preterm birth at less than 34 weeks of gestation (RR 0.84, 95% CI: 0.71–0.99; I² = 0%; P = 0.04), but not at less than 37 weeks (RR 0.96, 95% CI: 0.90–1.02; I² = 31%; P = 0.18). However, it increased the rates of postpartum hemorrhage (RR 1.32, 95% CI: 1.14–1.54; I² = 0%; P = 0.0003), placental abruption (RR 2.18, 95% CI: 1.10–4.32; I² = 16%; P = 0.02), and cesarean section (RR 1.053, 95% CI: 1.001–1.108; I² = 0%; P = 0.05). No significant effects were observed on hypertensive disorders of pregnancy or small for gestational age. Sensitivity analysis confirmed the robustness of the findings, and funnel plots indicated no significant publication bias.

Low-dose aspirin may reduce the risk of preterm birth at less than 34 weeks of gestation in nulliparous women but increases the risks of postpartum hemorrhage, placental abruption, and cesarean section. These findings underscore the importance of careful consideration when prescribing low-dose aspirin for preterm birth prevention in nulliparous women.

Source: bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-024-06413-2