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Aspirin use during pregnancy may be a potential risk for postpartum hemorrhage and increased blood loss: A systematic review and meta-analysis

  • Yi Jiang
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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  • Zhuoru Chen
    Affiliations
    The Children's Hospital of Fudan University, Shanghai 200000, China
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  • Yuting Chen
    Affiliations
    Department of Obstetrics and Gynecology Ultrasound, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
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  • Lijie Wei
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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  • Peng Gao
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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  • Jingyi Zhang
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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  • Xuan Zhou
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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  • Shenglan Zhu
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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  • Huiting Zhang
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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  • Yuanyuan Du
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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  • Chenyun Fang
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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  • Rui Su
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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  • Shaoshuai Wang
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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  • Jun Yu
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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  • Mengzhou He
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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  • Wencheng Ding
    Correspondence
    Corresponding Authors: Wencheng Ding. Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, Hubei 430030, China
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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  • Ling Feng
    Correspondence
    Corresponding Authors: Ling Feng, Ph.D, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, Hubei 430030, China
    Affiliations
    Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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Published:January 24, 2023DOI:https://doi.org/10.1016/j.ajogmf.2023.100878

      AJOG at a glance

      • A
        Why 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.
      • B
        What 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.
      • C
        What 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

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