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Preeclampsia reduced 1.7 X by aspirin (but reduced 7 X by Vitamin D) – Feb 2018

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, Volume 216, Issue 2, February 2017, Pages 95-97
https://doi.org/10.1016/j.ajog.2016.09.076
Presented as an oral presentation at the 14th World Congress in Fetal Medicine, Crete, Greece, June 23, 2015.

VitaminDWiki

Pages listed in BOTH the categories Pregnancy and Hypertension (preeclampsia)


Vitamin D also provides many other benefits during pregnancy

Healthy pregnancies need lots of vitamin D has the following summary

Problem
ReducesEvidence
0. Chance of not conceiving3.4 times Observe
1. Miscarriage 2.5 times Observe
2. Pre-eclampsia 3.6 timesRCT
3. Gestational Diabetes 3 times RCT
4. Good 2nd trimester sleep quality 3.5 times Observe
5. Premature birth 2 times RCT
6. C-section - unplanned 1.6 timesObserve
     Stillbirth - OMEGA-3 4 timesRCT - Omega-3
7. Depression AFTER pregnancy 1.4 times RCT
8. Small for Gestational Age 1.6 times meta-analysis
9. Infant height, weight, head size
     within normal limits
RCT
10. Childhood Wheezing 1.3 times RCT
11. Additional child is Autistic 4 times Intervention
12.Young adult Multiple Sclerosis 1.9 timesObserve
13. Preeclampsia in young adult 3.5 timesRCT
14. Good motor skills @ age 31.4 times Observe
15. Childhood Mite allergy 5 times RCT
16. Childhood Respiratory Tract visits 2.5 times RCT

RCT = Randomized Controlled Trial


See also VitaminDWiki


See also web


Background
Preeclampsia and fetal growth restriction are major causes of perinatal death and handicap in survivors. Randomized clinical trials have reported that the risk of preeclampsia, severe preeclampsia, and fetal growth restriction can be reduced by the prophylactic use of aspirin in high-risk women, but the appropriate dose of the drug to achieve this objective is not certain.

Objective
We sought to estimate the impact of aspirin dosage on the prevention of preeclampsia, severe preeclampsia, and fetal growth restriction.

Study Design
We performed a systematic review and meta-analysis of randomized controlled trials comparing the effect of daily aspirin or placebo (or no treatment) during pregnancy. We searched MEDLINE, Embase, Web of Science, and Cochrane Central Register of Controlled Trials up to December 2015, and study bibliographies were reviewed. Authors were contacted to obtain additional data when needed. Relative risks for preeclampsia, severe preeclampsia, and fetal growth restriction were calculated with 95% confidence intervals using random-effect models. Dose-response effect was evaluated using meta-regression and reported as adjusted R2. Analyses were stratified according to gestational age at initiation of aspirin (≤16 and >16 weeks) and repeated after exclusion of studies at high risk of biases.

Results
In all, 45 randomized controlled trials included a total of 20,909 pregnant women randomized to between 50-150 mg of aspirin daily. When aspirin was initiated at ≤16 weeks, there was a significant reduction and a dose-response effect for the

  • prevention of preeclampsia (relative risk, 0.57; 95% confidence interval, 0.43–0.75; P < .001; R2, 44%; P = .036),
  • severe preeclampsia (relative risk, 0.47; 95% confidence interval, 0.26–0.83; P = .009; R2, 100%; P = .008), and
  • fetal growth restriction (relative risk, 0.56; 95% confidence interval, 0.44–0.70; P < .001; R2, 100%; P = .044)

with higher dosages of aspirin being associated with greater reduction of the 3 outcomes. Similar results were observed after the exclusion of studies at high risk of biases. When aspirin was initiated at >16 weeks, there was a smaller reduction of preeclampsia (relative risk, 0.81; 95% confidence interval, 0.66–0.99; P = .04) without relationship with aspirin dosage (R2, 0%; P = .941). Aspirin initiated at >16 weeks was not associated with a risk reduction or a dose-response effect for severe preeclampsia (relative risk, 0.85; 95% confidence interval, 0.64–1.14; P = .28; R2, 0%; P = .838) and fetal growth restriction (relative risk, 0.95; 95% confidence interval, 0.86–1.05; P = .34; R2, not available; P = .563).

Conclusion
Prevention of preeclampsia and fetal growth restriction using aspirin in early pregnancy is associated with a dose-response effect. Low-dose aspirin initiated at >16 weeks’ gestation has a modest or no impact on the risk of preeclampsia, severe preeclampsia, and fetal growth restriction. Women at high risk for those outcomes should be identified in early pregnancy.

Created by admin. Last Modification: Friday August 24, 2018 21:21:05 GMT-0000 by admin. (Version 4)
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