Preconceptional low-dose aspirin for the prevention of hypertensive pregnancy complications and preterm delivery after IVF: a meta-analysis with individual patient data

Groeneveld, E.; Lambers, M.J.; Lambalk, Cornelis B.; Broeze, Kimiko A.; Haapsamo, Mervi; Sutter, Petra De; Schoot, B.C.; Schats, R.; Mol, Ben Willem J.; Hompes, Peter G.A.

doi:10.1093/humrep/det022

Cited by 40 publications

(21 citation statements)

References 33 publications

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“…Some authors such as Han et al and Beigi et al are of the conviction that anti-inflammatory treatments and anticoagulation treatments are good to use [21,22]. Whereas the utter conviction the other authors like Groeneveld et al [23] is that such treatments are not effective for pregnancy complications like preeclampsia.…”

Section: Resultsmentioning

confidence: 99%

Controversies on Preeclampsia through the lens of Reproductive Immunology: A Systematic Review

Ahmadi¹,

Shahsavar²,

Hasanvand³

2016

IJIMS

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Section: Resultsmentioning

confidence: 99%

Controversies on Preeclampsia through the lens of Reproductive Immunology: A Systematic Review

Ahmadi¹,

Shahsavar²,

Hasanvand³

2016

IJIMS

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“…Data concerning the use of aspirin for preventing hypertensive disorders in pregnancy are controversial as well. A RCT found such a benefit in the use of aspirin for the prevention of hypertensive complications of pregnancy [25], however, a recent meta-analysis with individual patient data did not recommend the low-dose aspirin for hypertensive complications and preterm delivery after IVF [26]. One study found low incidence of ovarian hyperstimulation syndrome in patients receiving low-dose aspirin [27].…”

Section: Low-dose Aspirinmentioning

confidence: 99%

Adjuvants Therapies for Women Undergoing IVF: Is There Any Evidence of their Safety and Efficacy? An Updated Mini-Review

Fabozzi¹

2017

OGIJ

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In the last two decades a series of adjuvant therapies have been proposed to improve the success of IVF and most of them are currently prescribed even though the quality of scientific evidence supporting their efficacy in improving live birth rates after IVF is weak. The aim of this paper is to describe some of the therapies mostly used by women undergoing IVF such as dehydroepiandrosterone, testosterone, low-dose aspirin, low-molecular-weight heparin (LMWH), corticosteroids and endometrial scratching, and to assess the current evidence about their safety and efficacy. (Relative Risk (RR) 2.13; 95% CI 1.12-4.08). Similar results were obtained in subgroup analyses including randomized controlled trials and case-control studies (RR 2.57; 95% CI 1.43-4.63) and self-controlled studies (RR 3.95;). However, the effects of DHEA on oocyte retrieval, implantation, and abortion were not significant. The Cochrane review conducted in 2015 showed higher ongoing pregnancy rates or live birth rates following the pre-treatment with DHEA. Nevertheless, no benefit was observed when studies with high risk of bias were excluded [14,15]. Finally, a third meta-analysis analysing the effect of DHEA in women with DOR including a total of nine studies, four RCTs, four retrospective and one prospective concluded that clinical pregnancy rates were increased significantly in DOR patients who were pre-treated with DHEA (OR = 1.47, 95% CI: 1.09-1.99), whereas no differences were observed in the number of oocytes retrieved, the cancellation rate of IVF cycles and them is carriage rate between the cases and controls (WMD= −0.69, 95% CI: −2.18-0.81; OR = 0.74,95% CI: 0.51-1.08; OR = 0.34, 95% CI: 0.10-1.24). However, restricting the analysis to only RCTs, a non-significant difference in the clinical pregnancy rate was observed(OR = 1.08, 95% CI: 0.67-1.73) [15]. Keywords: Conclusive statementAlthough the effect of DHEA on improving ovarian response seems to be promising, there is insufficient evidence to recommend DHEA supplementation at this time. Furthermore, the long-term risk of DHEA administration remain unknown. More RCTs with large sample size are needed to obtain good quality evidence on its safety and efficacy. Testosterone (TT)Testosterone is a downstream molecule in the steroidal pathway from DHEA. It can be administered either trans-dermally or orally. Different RCTs report a beneficial effect of TT pre-treatment [16,17] and the meta-analysis from Bosdou et al. [18] analyzing both trials conducted by Massin et al. [16] and Kim et al. [17] reported that pretreatment with transdermal testosterone was associated with an increase in clinical pregnancy (risk difference (RD): +15%, 95% confidence interval (CI): +3 to +26%) and live birth rates (RD: +11%, 95% CI: +0.3 to +22%) in poor responders undergoing ovarian stimulation for IVF. A second meta-analysis conducted by also reported that testosterone-treated women achieved a significantly higher live birth rate (risk ratio, RR, 1.91, 95% CI 1.01 to 3.63), clinical pregnancy ra...

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“…The ratio between the prostaglandins thromboxane and prostacyclin modulates vascular blood flow, with thromboxane A 2 acting as a vasoconstrictor and promoting platelet aggregation, while prostacyclin acts as a vasodilator and inhibits aggregation. Increased thromboxane and reduced prostacyclin levels are associated with infarction and thrombotic vasculopathy, which are well-known features in preeclamptic placentas [22]. …”

Section: Pathogenesismentioning

confidence: 99%

“…And, unlike high-dose NSAIDs, low-dose aspirin does not appear to increase the risk for ductus arteriosus closure in utero [45]. Analysis for preconceptional low-dose aspirin administration for prevention of preeclampsia after in vitro fertilization (IVF) found no significant reduction of hypertensive pregnancy complications compared to placebo group [22]. …”

Section: Clinical Trials Of Low-dose Aspirin Administration For Prmentioning

confidence: 99%

Aspirin for Prevention of Preeclampsia in Lupus Pregnancy

Schramm

Clowse

2014

Autoimmune Diseases

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Preeclampsia, the onset of hypertension and proteinuria during pregnancy, is a common medical disorder with high maternal and fetal mortality and morbidity. The underlying pathology remains poorly understood and includes inflammation, endothelial dysfunction, and an unbalanced thromboxane A2/prostacyclin ratio. For women with systemic lupus erythematosus (SLE), particularly those with preexisting renal disease or with active lupus, the risk of developing preeclampsia is up to 14% higher than it is among healthy individuals. The mechanism is still unknown and the data for preventing preeclampsia in lupus pregnancies are rare. Modulating the impaired thromboxane A2/prostacyclin ratio by administration of low-dose aspirin appears to be the current best option for the prevention of preeclampsia. After providing an overview of the pathogenesis of preeclampsia, preeclampsia in lupus pregnancies, and previous trials for prevention of preeclampsia with aspirin treatment, we recommend low-dose aspirin administration for all lupus patients starting prior to 16 weeks of gestation. Patients with SLE and antiphospholipid syndrome should receive treatment with heparin and low-dose aspirin during pregnancy.

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Preconceptional low-dose aspirin for the prevention of hypertensive pregnancy complications and preterm delivery after IVF: a meta-analysis with individual patient data

Abstract: Based on the current meta-analysis with IPD we found no confirmation for the hypothesis that preconceptionally started low-dose aspirin reduces the incidence of hypertensive pregnancy complications or preterm delivery in IVF women. Larger studies are warranted.

Cited by 40 publications

References 33 publications

Controversies on Preeclampsia through the lens of Reproductive Immunology: A Systematic Review

Controversies on Preeclampsia through the lens of Reproductive Immunology: A Systematic Review

Adjuvants Therapies for Women Undergoing IVF: Is There Any Evidence of their Safety and Efficacy? An Updated Mini-Review

Aspirin for Prevention of Preeclampsia in Lupus Pregnancy

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