The Effectiveness, Safety and Outcome of Low Dose Aspirin for The Prevention of Superimposed Preeclampsia in Women with Chronic Hypertension : A Comprehensive Systematic Review
Keywords:
low-dose aspirin, chronic hypertension, superimposed pre-eclampsiaAbstract
Background: Low-dose aspirin therapy has been shown to reduce pregnancy-related complications, including pre-eclampsia, in pregnant women with chronic hypertension. However, mixed findings suggest that it does not significantly alter the likelihood of developing superimposed pre-eclampsia, preterm birth, or perinatal mortality in women with chronic hypertension. Methods: This systematic review complied with the PRISMA 2020 requirements, concentrating solely on full-text papers published in English from 2014 to 2024. Editorials and review articles lacking a DOI were omitted to guarantee the use of high-quality sources. A comprehensive literature review was performed using esteemed databases such as ScienceDirect, PubMed, and SagePub to locate pertinent studies. Result: The initial database search identified over 200 publications relevant to the topic. Following a meticulous three-stage screening process, eight studies were selected that met the predefined inclusion criteria for comprehensive analysis. These studies were subjected to a rigorous critical evaluation, providing an in-depth investigation into the effectiveness, safety, and outcomes of low-dose aspirin for the prevention of superimposed pre-eclampsia. This focused approach ensured that the analysis drew from high-quality evidence directly aligned with the study's objectives. Conclusion: Superimposed preeclampsia, a condition causing preterm birth and neonatal intensive care unit admissions, is a risk for chronic hypertension women. Aspirin, a low-dose medication, has shown mixed efficacy in preventing this condition, with dose-dependent effectiveness.
References
Steegers, E. A., Von Dadelszen, P., Duvekot, J. J., & Pijnenborg, R. (2010). Pre-eclampsia. The Lancet, 376(9741), 631–644. https://doi.org/10.1016/s0140-6736(10)60279-6
Phipps, E. A., Thadhani, R., Benzing, T., & Karumanchi, S. A. (2019). Pre-eclampsia: pathogenesis, novel diagnostics and therapies. Nature Reviews Nephrology, 15(5), 275–289. https://doi.org/10.1038/s41581-019-0119-6
Dimitriadis, E., Rolnik, D. L., Zhou, W., Estrada-Gutierrez, G., Koga, K., Francisco, R. P. V., Whitehead, C., Hyett, J., da Silva Costa, F., Nicolaides, K., & Menkhorst, E. (2023). Pre-eclampsia. Nature reviews. Disease primers, 9(1), 8. https://doi.org/10.1038/s41572-023-00417-6
Choi, Y. J., & Shin, S. (2021). Aspirin Prophylaxis During Pregnancy: A Systematic Review and Meta-Analysis. American journal of preventive medicine, 61(1), e31–e45. https://doi.org/10.1016/j.amepre.2021.01.032
Ahn, T. G., & Hwang, J. Y. (2023). Preeclampsia and aspirin. Obstetrics & gynecology science, 66(3), 120–132. https://doi.org/10.5468/ogs.22261
Nzelu, D., Palmer, T., Stott, D., Pandya, P., Napolitano, R., Casagrandi, D., Ammari, C., & Hillman, S. (2024). First trimester screening for pre-eclampsia and targeted aspirin prophylaxis: a cost-effectiveness cohort study. BJOG : an international journal of obstetrics and gynaecology, 131(2), 222–230. https://doi.org/10.1111/1471-0528.17598
D'Antonio, F., Khalil, A., Rizzo, G., Fichera, A., Herrera, M., Buca, D., Morelli, R., Cerra, C., Orabona, R., Acuti Martellucci, C., Flacco, M. E., & Prefumo, F. (2023). Aspirin for prevention of preeclampsia and adverse perinatal outcome in twin pregnancies: a systematic review and meta-analysis. American journal of obstetrics & gynecology MFM, 5(2), 100803. https://doi.org/10.1016/j.ajogmf.2022.100803
Richards, E. M. F., Giorgione, V., Stevens, O., & Thilaganathan, B. (2023). Low-dose aspirin for the prevention of superimposed preeclampsia in women with chronic hypertension: a systematic review and meta-analysis. American journal of obstetrics and gynecology, 228(4), 395–408. https://doi.org/10.1016/j.ajog.2022.09.046
ACOG Committee Opinion No. 743: Low-Dose Aspirin Use During Pregnancy. (2018). Obstetrics and gynecology, 132(1), e44–e52. https://doi.org/10.1097/AOG.0000000000002708
Hybiak, J., Broniarek, I., Kiryczyński, G., Los, L. D., Rosik, J., Machaj, F., Sławiński, H., Jankowska, K., & Urasińska, E. (2020). Aspirin and its pleiotropic application. European journal of pharmacology, 866, 172762. https://doi.org/10.1016/j.ejphar.2019.172762
Roberge, S., Nicolaides, K., Demers, S., Hyett, J., Chaillet, N., & Bujold, E. (2017). The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. American journal of obstetrics and gynecology, 216(2), 110–120.e6. https://doi.org/10.1016/j.ajog.2016.09.076
Rolnik, D. L., Wright, D., Poon, L. C., O'Gorman, N., Syngelaki, A., de Paco Matallana, C., Akolekar, R., Cicero, S., Janga, D., Singh, M., Molina, F. S., Persico, N., Jani, J. C., Plasencia, W., Papaioannou, G., Tenenbaum-Gavish, K., Meiri, H., Gizurarson, S., Maclagan, K., & Nicolaides, K. H. (2017). Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. The New England journal of medicine, 377(7), 613–622. https://doi.org/10.1056/NEJMoa1704559
Hauspurg, A., Sutton, E. F., Catov, J. M., & Caritis, S. N. (2018). Aspirin Effect on Adverse Pregnancy Outcomes Associated With Stage 1 Hypertension in a High-Risk Cohort. Hypertension, 72(1), 202–207. https://doi.org/10.1161/hypertensionaha.118.11196
Banala, C., Moreno, S., Cruz, Y., Boelig, R. C., Saccone, G., Berghella, V., Schoen, C. N., & Roman, A. (2020). Impact of the ACOG guideline regarding low-dose aspirin for prevention of superimposed preeclampsia in women with chronic hypertension. American Journal of Obstetrics and Gynecology, 223(3), 419.e1-419.e16. https://doi.org/10.1016/j.ajog.2020.03.004
SMFM Patient Safety and Quality Committee. Electronic address: smfm@smfm.org, Combs, C. A., & Montgomery, D. M. (2020). Society for Maternal-Fetal Medicine Special Statement: Checklists for preeclampsia risk-factor screening to guide recommendations for prophylactic low-dose aspirin. American journal of obstetrics and gynecology, 223(3), B7–B11. https://doi.org/10.1016/j.ajog.2020.06.003
Shen, L., Martinez-Portilla, R. J., Rolnik, D. L., & Poon, L. C. (2021). ASPRE trial: risk factors for development of preterm pre-eclampsia despite aspirin prophylaxis. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 58(4), 546–552. https://doi.org/10.1002/uog.23668
Rottenstreich, A. (2024). Controversies and Clarifications Regarding the Role of Aspirin in Preeclampsia Prevention: A Focused Review. Journal of Clinical Medicine, 13(15), 4427. https://doi.org/10.3390/jcm13154427
Zhang, F., & Wang, H. (2024). Effect of low-dose aspirin intervention on pre-eclampsia prevention in high-risk pregnant women and its impact on postpartum hemorrhage. Frontiers in medicine, 11, 1414697. https://doi.org/10.3389/fmed.2024.1414697
van Oostwaard, M. F., Langenveld, J., Schuit, E., Papatsonis, D. N., Brown, M. A., Byaruhanga, R. N., Bhattacharya, S., Campbell, D. M., Chappell, L. C., Chiaffarino, F., Crippa, I., Facchinetti, F., Ferrazzani, S., Ferrazzi, E., Figueiró-Filho, E. A., Gaugler-Senden, I. P., Haavaldsen, C., Lykke, J. A., Mbah, A. K., Oliveira, V. M., … Ganzevoort, W. (2015). Recurrence of hypertensive disorders of pregnancy: an individual patient data metaanalysis. American journal of obstetrics and gynecology, 212(5), . https://doi.org/10.1016/j.ajog.2015.01.009
Caritis, S., Sibai, B., Hauth, J., Lindheimer, M. D., Klebanoff, M., Thom, E., VanDorsten, P., Landon, M., Paul, R., Miodovnik, M., Meis, P., & Thurnau, G. (1998). Low-dose aspirin to prevent preeclampsia in women at high risk. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. The New England journal of medicine, 338(11), 701–705. https://doi.org/10.1056/NEJM199803123381101
Shanmugalingam, R., Wang, X., Münch, G., Fulcher, I., Lee, G., Chau, K., Xu, B., Kumar, R., Hennessy, A., & Makris, A. (2019). A pharmacokinetic assessment of optimal dosing, preparation, and chronotherapy of aspirin in pregnancy. American journal of obstetrics and gynecology, 221(3), 255.e1–255.e9. https://doi.org/10.1016/j.ajog.2019.04.027
Finneran, M. M., Gonzalez-Brown, V. M., Smith, D. D., Landon, M. B., & Rood, K. M. (2019). Obesity and laboratory aspirin resistance in high-risk pregnant women treated with low-dose aspirin. American journal of obstetrics and gynecology, 220(4), 385.e1–385.e6. https://doi.org/10.1016/j.ajog.2019.01.222
Chappell, L. C., Enye, S., Seed, P., Briley, A. L., Poston, L., & Shennan, A. H. (2008). Adverse perinatal outcomes and risk factors for preeclampsia in women with chronic hypertension: a prospective study. Hypertension (Dallas, Tex. : 1979), 51(4), 1002–1009. https://doi.org/10.1161/HYPERTENSIONAHA.107.107565
Boriboonhirunsarn, D., Pradyachaipimol, A., & Viriyapak, B. (2017). Incidence of superimposed preeclampsia among pregnant Asian women with chronic hypertension. Hypertension in pregnancy, 36(2), 226–231. https://doi.org/10.1080/10641955.2017.1311340
Morgan, J. L., Nelson, D. B., Roberts, S. W., Wells, C. E., McIntire, D. D., & Cunningham, F. G. (2016). Association of Baseline Proteinuria and Adverse Outcomes in Pregnant Women With Treated Chronic Hypertension. Obstetrics and gynecology, 128(2), 270–276. https://doi.org/10.1097/AOG.0000000000001517
Ahrens, K. A., Silver, R. M., Mumford, S. L., Sjaarda, L. A., Perkins, N. J., Wactawski-Wende, J., Galai, N., Townsend, J. M., Lynch, A. M., Lesher, L. L., Faraggi, D., Zarek, S., & Schisterman, E. F. (2016). Complications and Safety of Preconception Low-Dose Aspirin Among Women With Prior Pregnancy Losses. Obstetrics and gynecology, 127(4), 689–698. https://doi.org/10.1097/AOG.0000000000001301
Chaemsaithong, P., Cuenca-Gomez, D., Plana, M. N., Gil, M. M., & Poon, L. C. (2020). Does low-dose aspirin initiated before 11 weeks' gestation reduce the rate of preeclampsia?. American journal of obstetrics and gynecology, 222(5), 437–450. https://doi.org/10.1016/j.ajog.2019.08.047
Hoffman, M. K., Goudar, S. S., Kodkany, B. S., Metgud, M., Somannavar, M., Okitawutshu, J., Lokangaka, A., Tshefu, A., Bose, C. L., Mwapule, A., Mwenechanya, M., Chomba, E., Carlo, W. A., Chicuy, J., Figueroa, L., Garces, A., Krebs, N. F., Jessani, S., Zehra, F., Saleem, S., … ASPIRIN Study Group (2020). Low-dose aspirin for the prevention of preterm delivery in nulliparous women with a singleton pregnancy (ASPIRIN): a randomised, double-blind, placebo-controlled trial. Lancet (London, England), 395(10220), 285–293. https://doi.org/10.1016/S0140-6736(19)32973-3
O'Gorman, N., Wright, D., Poon, L. C., Rolnik, D. L., Syngelaki, A., de Alvarado, M., Carbone, I. F., Dutemeyer, V., Fiolna, M., Frick, A., Karagiotis, N., Mastrodima, S., de Paco Matallana, C., Papaioannou, G., Pazos, A., Plasencia, W., & Nicolaides, K. H. (2017). Multicenter screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation: comparison with NICE guidelines and ACOG recommendations. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 49(6), 756–760. https://doi.org/10.1002/uog.17455
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Andi Muh. Ariansyah Nazaruddin, Pramuliansyah Haq (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors publishing here keep copyright but grant the journal first publication rights, under a Creative Commons Attribution-NonCommercial 4.0 License. They can distribute their work non-exclusively elsewhere with an acknowledgment of its first publication in this journal. Posting the work online before and during submission for earlier and greater citation is encouraged, reflecting Open Access benefits.
