Should we recommend universal aspirin for all pregnant women?

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• 作者：Fionnuala Mone ; MRCOG^a ; Cecilia Mulcahy ; MSc^a ; Peter McParland ; FRCOG^a ; ^b ; Fionnuala M. McAuliffe ; FRCOG^a ; ^b ; ^{Fionnuala.mcauliffe@ucd.ie}
• 关键词：fetal growth restriction ; low-dose aspirin ; preeclampsia ; universal
• 刊名：American Journal of Obstetrics and Gynecology
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：216
• 期：2
• 页码：141.e1-141.e5
• 全文大小：203 K
• 卷排序：216

文摘

Low-dose aspirin has been demonstrated to reduce the incidence of preeclampsia and fetal growth restriction in at-risk populations. Its role in low-risk populations is as yet unknown. Novel preeclampsia screening tests are emerging that can predict the risk of the development of preeclampsia from as early as 11 weeks of gestation. It may be more efficacious, acceptable, and cost-effective to prescribe low-dose aspirin to all pregnant women from the first trimester as opposed to performing a screening test in the first instance. There is variation in opinion: the American College of Obstetricians and Gynecologists suggests the use of aspirin only in women who are at risk of preeclampsia, based on patient history; the National Institute for Health and Clinical Excellence, UK, and the US Preventative Services Task Force recommend the use of low-dose aspirin if there is 1 major or 2 moderate risk factors. This point-counterpoint discussion shall address (1) controversies regarding the real impact of low-dose aspirin; (2) controversies in the actual guidelines among the different national societies; (3) controversies regarding emerging preeclampsia screening tests in terms of cost-effectiveness and efficacy, and (4) points in favor of the provision of universal vs screened-positive women.