| Excerpt from The WHO Reproductive Health Library | Published by Update Software Ltd. |
For prevention, the use of antiplatelet agents, mainly aspirin, was associated with 19 % reduction in the risk of pre-eclampsia (relative risk [RR]: 0.81; 95% confidence interval [CI]: 0.75 to 0.88) and a 16 % reduction in the risk of fetal or neonatal death (RR: 0.84; 95% CI: 0.74 to 0.96). The reduction in the risk of pre-eclampsia were greater in the trials of high risk women (RR 0.73, 95% CI 0.64 to 0.83) compared with moderate-risk women (RR 0.85, 95% CI 0.77 to 0.94) and in trials evaluating more than 75 mg/day dose of aspirin (RR 0.49, 95% CI 0.38 to 0.65) compared with those that evaluated less than 75 mg/day of aspirin (RR 0.86, 95% CI 0.79 to 0.93).These results were consistent regardless of the length of gestation at entry into the trial. However, there was no effect on the risk of preterm delivery, pregnancy-induced hypertension, size of infant for gestational age, placental abruption, and need for induction of labour or caesarean section.
It must be noted that the largest studies included failed to demonstrate any clinically significant reduction in pre-eclampsia and fetal or neonatal death. These six studies included, more than 26000 women (79 % of total of women included in the review).
Despite an exhaustive search, the funnel plot analysis of the data for pre-eclampsia show possible risk of publication bias affecting the review. There was no attempt to incorporate study quality either in analysis or in generating inferences.
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