阿斯匹林的使用與不良妊娠結局相關：統合分析

背景：在妊娠期間使用阿斯匹林可能對於妊娠結局具有影響。方法：使用實證醫學的步驟，搜集彙整文獻並加以評讀後挑出有品質的研究進行統合分析。所使用的資料庫包括PubMed（1966-2013）、EMBASE（1980-2013）TOXLINE (1994-2013)，EB M Cochrane Database of Systematic Reviews (1991-2013)，使用阿斯匹林（aspirin）和水楊酸（salicylic acid）作為關鍵字尋找符合主題的隨機對照試驗研究（randomized controlled trials）進行評讀，將評讀後的研究進行統合分析（meta-analysis）。結果：共有44項研究納入分析，個別提取其研究的數值進行統合分析得知結果。在隨機效應模式（random effect model）觀察到阿斯匹林和安慰劑的使用對於流產的危險沒有顯著差異（9項研究；RR,0.96；95% CI, 0.76– 1.22）；但在早產的危險中則具有顯著差異（23項研究；RR,0.88；95% CI, 0.81– 0.96）。此外，在週產期死亡的危險中阿斯匹林和安慰劑的使用沒有顯著差異（16項研究；RR,0.93；95% CI, 0.80– 1.07）；同樣地，在胎兒小於妊娠年齡（SGA）的危險中，阿斯匹林和安慰劑的使用沒有顯著差異（16項研究；RR,0.88；95% CI, 0.74– 1.06）。結論：在妊娠期間，使用阿斯匹林對於早產有顯著降低危險的效果；不過在流產、週產期死亡、胎兒小於妊娠年齡（SGA）、Apgar分數則沒有顯著的效果。

關鍵字

阿斯匹林；妊娠結局；統合分析

並列摘要

BACKGROUND: Assessed the effects of aspirin use on pregnant mothers, their fetuses, and on the pregnancy outcomes. METHODS: Used the keywords aspirin and salicylic acid to search for articles in PubMed (1966-2013), EMBASE (1980-2013), TOXLINE (1994-2013), EBM Cochrane Database of Systematic Reviews (1991-2013), All articles were reviewed and selected for meta-analysis. RESULTS: Data from pooled from 44 studies and analyzed. Under the random effect model, the risk of miscarriage did not show significant association to both aspirin and placebo use (9 studies; RR,0.96；95% CI, 0.76–1.22). The risk of preterm delivery showed significant association to both aspirin and placebo use (23 studies; RR,0.88；95% CI, 0.81– 0.96). The risk of perinatal mortality did not show significant difference between aspirin and placebo use (16 studies; RR,0.93；95% CI, 0.80– 1.07). The risk of small-for-gestational-age infants did not show significant association to both aspirin and placebo use (16 studies; RR, 0.88；95% CI, 0.74– 1.06) CONCLUSION: Aspirin use during gestation decrease the risk of preterm delivery, but has no effect on miscarriage, perinatal mortality and small-for-gestational-age infants.

並列關鍵字

aspirin ； pregnancy outcomes ； meta-analysis

參考文獻

APGAR, V. (1953). A proposal for a new method of evaluation of the newborn infant. Current Researches in Anesthesia & Analgesia, 32(4), 260-267.

Avery, G. B. (1975). Neonatology: Pathophysiology and management of the newborn J. B. Lippincott Company.

Barker, D. J. (1999). Early growth and cardiovascular disease. Archives of Disease in Childhood, 80(4), 305-307.

Battaglia, F. C., & Lubchenco, L. O. (1967). A practical classification of newborn infants by weight and gestational age. The Journal of Pediatrics, 71(2), 159-163.

Bellamy, L., Casas, J. P., Hingorani, A. D., & Williams, D. J. (2007). Pre-eclampsia and risk of cardiovascular disease and cancer in later life: Systematic review and meta-analysis. BMJ (Clinical Research Ed.), 335(7627), 974.

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阿斯匹林的使用與不良妊娠結局相關：統合分析

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