Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/86312
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Type: Journal article
Title: Preconceptional low-dose aspirin for the prevention of hypertensive pregnancy complications and preterm delivery after IVF: a meta-analysis with individual patient data
Author: Groeneveld, E.
Lambers, M.
Lambalk, C.
Broeze, K.
Haapsamo, M.
de Sutter, P.
Schoot, B.
Schats, R.
Mol, B.
Hompes, P.
Citation: Human Reproduction, 2013; 28(6):1480-1488
Publisher: Oxford University Press
Issue Date: 2013
ISSN: 0268-1161
1460-2350
Statement of
Responsibility: 
E. Groeneveld, M.J. Lambers, C.B. Lambalk, K.A. Broeze, M. Haapsamo, P. de Sutter, B.C. Schoot, R. Schats, B.W.J. Mol, and P.G.A. Hompes
Abstract: STUDY QUESTION Does preconceptionally started low-dose aspirin prevent hypertensive pregnancy complications and preterm delivery in IVF patients? SUMMARY ANSWER The current data do not support the use of preconceptionally started low-dose aspirin treatment for the prevention of hypertensive pregnancy complications and preterm delivery in IVF women. WHAT IS KNOWN ALREADY Studies starting low-dose aspirin treatment as prevention in the second trimester of pregnancy found no or only moderate reductions in the relative risk of developing pre-eclampsia. Low-dose aspirin was possibly started too late, that is after the first episode of trophoblast invasion. STUDY DESIGN, SIZE, DURATION We performed a meta-analysis with individual patient data (IPD), in which four authors could provide IPD on a total of 268 pregnancies (n = 131 treated with aspirin, n = 137 placebo). Data on hypertensive pregnancy complications and preterm delivery were collected. PARTICIPANTS/MATERIALS, SETTING, METHODS All separate databases were merged into a summary database. Treatment effect of aspirin on the incidence of hypertensive pregnancy complications (n = 187) and preterm delivery (n = 180) were estimated with odds ratios (OR) and 95% confidence intervals (95% CI) using multivariable logistic regression. MAIN RESULTS AND THE ROLE OF CHANCE There were significantly fewer twin pregnancies in the aspirin group (OR 0.55 95% CI 0.30–0.98), but no significant differences for hypertensive pregnancy complications and preterm delivery: for singletons OR 0.62 (95% CI 0.22–1.7) and OR 0.52 (95% CI 0.16–1.7), respectively, as well as for twin pregnancies OR 1.2 (95% CI 0.35–4.4) and OR 1.6 (95% CI 0.51–5.0), respectively. LIMITATIONS, REASONS FOR CAUTION We have to bear in mind that the included studies showed clinical heterogeneity; there was variation in the duration of low-dose aspirin therapy and degree of hypertension between the different studies. Although we combined IPD from four studies, we have to realize that the studies were not powered for the outcome of the current IPD meta-analysis. WIDER IMPLICATIONS OF THE FINDINGS Based on the current meta-analysis with IPD we found no confirmation for the hypothesis that preconceptionally started low-dose aspirin reduces the incidence of hypertensive pregnancy complications or preterm delivery in IVF women. Larger studies are warranted. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER not applicable.
Keywords: Aspirin; hypertensive pregnancy complications; IVF; pre-eclampsia; early pregnancy
Description: First published online: March 25, 2013
Rights: © The Author 2013
RMID: 0020136877
DOI: 10.1093/humrep/det022
Appears in Collections:Obstetrics and Gynaecology publications

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