OBJECTIVE
This study aimed to investigate the potential role of aspirin in reducing the risk
of preeclampsia and adverse maternal and perinatal outcomes in twin pregnancies.
DATA SOURCES
Medline, Embase, Google Scholar, Cochrane, and ClinicalTrial.gov databases were searched.
STUDY ELIGIBILITY CRITERIA
The search and selection criteria were restricted to the English language.
METHODS
The primary outcome was the incidence of preeclampsia. The secondary outcomes included
gestational hypertension; fetal growth restriction; preterm birth, either spontaneous
or iatrogenic, before 34 weeks of gestation; gestational age at birth; neonatal birthweight;
and adverse events secondary to the administration of aspirin, including antepartum
and postpartum hemorrhage. In addition, subgroup analyses according to chorionicity
(dichorionic vs monochorionic), aspirin dose, and gestational age at administration
of aspirin (<16 vs ≥16 weeks of gestation) and considering only studies with a daily
aspirin dose of ≥100 mg/d were performed. Head-to-head meta-analyses reporting results
as summary odds ratios and mean differences were used to analyze categorical and continuous
variables, respectively. Quality assessment for randomized controlled trials was independently
performed by 2 researchers based on the risk of bias that was assessed using the revised
Cochrane risk-of-bias tool for randomized trials. The conclusion of the meta-analysis
on the primary outcome was assessed using the Grading of Recommendations, Assessment,
Development, and Evaluation.
RESULTS
Overall, 9 studies (2273 twin pregnancies) were included. When considering all studies,
the risk of preeclampsia was lower in twin pregnancies treated with aspirin than in
those not treated with aspirin (odds ratio, 0.64; 95% confidence interval, 0.48–0.85;
P=.003), although there was no significant difference in the risk of gestational hypertension
(P=.987), fetal growth restriction (P=.9), or adverse maternal and perinatal events (P=.9) in twin pregnancies treated with aspirin compared with those not treated with
aspirin. There was no significant difference in the gestational age at birth (P=.2) and neonatal birthweight (P=.06) between women receiving aspirin and those not receiving aspirin. When considering
only studies with an aspirin dose of >100 mg/d, the risk of preeclampsia (odds ratio,
0.45; 95% confidence interval, 0.23–0.86; P=.02) was significantly lower in pregnancies receiving aspirin than in those not receiving
aspirin, Conversely, there was no significant difference in the risk of gestational
hypertension (P=.20), fetal growth restriction (P=.1), gestational age at birth (P=.06), and neonatal weight (P=.05) between the 2 groups. Furthermore, there was no significant difference in the
risk of preeclampsia when considering only studies with an aspirin dose of >80 mg/d
(P=.611). The association between the administration of aspirin and preeclampsia persisted
when considering an aspirin dose of >100 mg/day or when the medication was started
before 16 weeks of gestation. The overall quality of evidence using the Grading of
Recommendations, Assessment, Development, and Evaluation assessment was low.
CONCLUSION
The administration of aspirin in women with twin pregnancies reduced the risk of preeclampsia.
The findings from this study highlighted the need for randomized controlled trials
elucidating the actual role of aspirin in affecting maternal and perinatal outcomes
in twin pregnancies.
Key words
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Article info
Publication history
Published online: November 16, 2022
Accepted:
November 5,
2022
Received in revised form:
October 27,
2022
Received:
September 20,
2022
Footnotes
The authors report no conflict of interest.
No funding was obtained for this systematic review.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
