AJOG at a glance
- AWhy was this study conducted?
- •Although pregnant women at risk of eclampsia have been shown to benefit from aspirin, the potential bleeding risk of aspirin should not be ignored.
- •Studies of the association between aspirin and postpartum hemorrhage have been controversial.
- •A major limitation of the available meta-analyses is a lack of robust definition of postpartum hemorrhage in most studies cited, compared with which the amount of postpartum blood loss may be more reliable. However, no meta-analyses have focused on the association between aspirin use during pregnancy and the specific amount of postpartum blood loss.
- •
- BWhat are the key findings?
- •Aspirin use during pregnancy is one possible reason for the increased risk of postpartum hemorrhage.
- •Aspirin use during pregnancy do slightly increase the amount of postpartum blood loss.
- •The conclusions are more likely to be obtained in developed countries.
- •
- CWhat does this study add to what is already known?
- •This is the first study to explore the relationship between aspirin use during pregnancy and the amount of postpartum blood loss.
- •Without denying the combined value of aspirin, our conclusions raise alarm for clinicians to postpartum hemorrhage in women using aspirin during pregnancy.
- •
Abstract
Objective
The association between aspirin use during pregnancy and risk for postpartum hemorrhage
remains unclear. We aimed to explore the incidence of postpartum hemorrhage and the
amount of postpartum blood loss among women who used aspirin during pregnancy.
Data Sources
From inception through October 2021, we explored MEDLINE, Web of Science, Embase and
Cochrane Central Register of Controlled Trials.
Study Eligibility
Studies comparing pregnancy outcomes which covered the incidence of postpartum hemorrhage
or amount of postpartum blood loss in pregnancies with aspirin versus placebo (or
no aspirin) were included.
Study Appraisal and Synthesis Methods
Reviewers separately ascertained studies, obtained data, and gauged study quality.
Meta-analysis was conducted by random effects model owing to the probable heterogeneity
of included studies. The rate of postpartum hemorrhage or the mean amount of postpartum
blood loss were compared and odds ratios (ORs) or mean differences (MDs) with 95%
confidence intervals (CIs) were estimated. Two parts performed both a pooled analysis
of RCTs and cohort studies and a separate analysis of RCTs.
Results
Overall, 21 studies with 373,926 women were included in postpartum hemorrhage part
and 7 studies with 10,163 women were included in postpartum blood loss part. The results
suggested that aspirin use during pregnancy was associated with increased incidence
of postpartum hemorrhage (OR=1.20, 95% CI: 1.07 to 1.34). When only RCTs were retained,
the results remained significant (OR=1.12, 95% CI: 1.00 to 1.25). In second part,
higher total blood loss after delivery was obtained (MD: 12.85 ml, 95% CI: 3.28 to
22.42) and the result was unaltered when cohort studies were eliminated (MD:13.72
ml, 95% CI: 4.63 ml to 22.81 ml). The conclusions are more likely to be obtained in
developed country.
Conclusions
Aspirin use during pregnancy is a potential risk for postpartum hemorrhage and do
slightly increase the amount of postpartum blood loss. Without denying the combined
value of aspirin, our conclusions raise alarm for clinicians to postpartum hemorrhage
in women using aspirin during pregnancy.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Obstetrics & Gynecology MFMAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
Article info
Publication history
Accepted:
January 18,
2023
Received in revised form:
January 14,
2023
Received:
January 10,
2023
Publication stage
In Press Accepted ManuscriptFootnotes
Conflict of interest: The authors report no conflict of interest.
Funding: This work was supported by the Nation Key Research and Development Program of China (2021YFC2701502)
PROSPERO: CRD42022373254
Paper presentations: This paper has not been presented at any meetings
Condensation: Aspirin use during pregnancy may increase the risk of postpartum hemorrhage and the amount of postpartum blood loss.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
