Aspirin for the prevention of pre-eclampsia in women with pre-existing diabetes: Systematic review.

Autor: Zen M; Westmead Institute for Maternal & Fetal Medicine, Westmead Hospital, Sydney, New South Wales, Australia.; Westmead Clinical School, Faculty of Medicine and Health, Westmead Hospital, The University of Sydney, Sydney, New South Wales, Australia., Haider R; Department of Endocrinology, Nepean Hospital, Sydney, New South Wales, Australia., Simmons D; Macarthur Clinical School, Western Sydney University, Sydney, New South Wales, Australia., Peek M; ANU Medical School, The Australian National University, Canberra, Australian Capital Territory, Australia., Nolan CJ; ANU Medical School, The Australian National University, Canberra, Australian Capital Territory, Australia., Padmanabhan S; Westmead Clinical School, Faculty of Medicine and Health, Westmead Hospital, The University of Sydney, Sydney, New South Wales, Australia.; Department of Diabetes & Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia., Jesudason S; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia., Alahakoon TI; Westmead Institute for Maternal & Fetal Medicine, Westmead Hospital, Sydney, New South Wales, Australia.; Westmead Clinical School, Faculty of Medicine and Health, Westmead Hospital, The University of Sydney, Sydney, New South Wales, Australia., Cheung NW; Westmead Clinical School, Faculty of Medicine and Health, Westmead Hospital, The University of Sydney, Sydney, New South Wales, Australia.; Department of Diabetes & Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia., Lee VW; Westmead Clinical School, Faculty of Medicine and Health, Westmead Hospital, The University of Sydney, Sydney, New South Wales, Australia.; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.; Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia.
Jazyk: angličtina
Zdroj: The Australian & New Zealand journal of obstetrics & gynaecology [Aust N Z J Obstet Gynaecol] 2022 Feb; Vol. 62 (1), pp. 12-21. Date of Electronic Publication: 2021 Nov 21.
DOI: 10.1111/ajo.13460
Abstrakt: Background: There is a lack of evidence for pre-eclampsia prophylaxis with aspirin in women with pre-existing diabetes mellitus (DM).
Aims: To examine the evidence for aspirin in pre-eclampsia prophylaxis in women with pre-existing DM.
Material and Methods: An electronic search using Ovid MEDLINE, Embase, CinicalTrials.gov and the Cochrane CENTRAL register of controlled trials through to February 2021 was performed. Reference lists of identified studies, previous review articles, clinical practice guidelines and government reports were manually searched. Randomised controlled trials (RCTs) of aspirin vs placebo for pre-eclampsia prophylaxis were included. Articles were manually reviewed to determine if cohorts included women with DM. The systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data from included trials were extracted independently by two authors who also independently assessed risk of bias as per the Cochrane Handbook criteria version 5.1.0. Data were analysed using Rev-Man 5.4.
Results: Forty RCTs were identified, of which 11 included a confirmed subset of women with DM; however, data were insufficient for meta-analysis. Meta-analysis of 930 women with DM, from individual patient data included in a systematic review and unpublished data from one of the 11 RCTs, showed a non-significant difference in the outcome of pre-eclampsia in participants treated with aspirin compared to placebo (odds ratio 0.58; 95% CI 0.20-1.71; P = 0.33).
Conclusions: Pre-eclampsia risk reduction with aspirin prophylaxis in women with pre-existing DM may be similar to women without pre-existing DM. However, randomised data within this meta-analysis were insufficient, warranting the need for further studies within this high-risk group of women.
(© 2021 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)
Databáze: MEDLINE
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