Prevention of pre‐eclampsia with aspirin: A systematic review of guidelines and evaluation of the quality of recommendation evidence

AbstractBackgroundEvidence has shown significant benefits of aspirin for preventing pre‐eclampsia.ObjectivesThe objective of this study was to systematically review recommendations from clinical practice guidelines and other recommendation documents on aspirin for the prevention of pre‐eclampsia.Search strategyTen databases were searched for statements from December 1, 2013, to January 1, 2022.Selection criteriaWithout language restrictions, the most recent version of documents was considered.Data collection and analysisTwo authors independently extracted recommendations. Guideline quality was assessed using a modified AGREE‐II instrument and the AGREE‐REX tool.Main resultsOut of 48 statements on the prevention of pre‐eclampsia, 46 had recommendations on use of aspirin. Of them, 39 were supported by evidence from systematic reviews or randomized controlled trials. Three statements reported aspirin's significant reductions in preterm pre‐eclampsia and one in perinatal death. Concerning quality, 41% of statements were rated as high quality in all domains of the AGREE‐II tool, 15% were rated high quality in all domains of the AGREE‐REX tool, and 11% were rated high quality in all domains on both tools.ConclusionsWhile 96% of statements advocated for use of aspirin, only 9% reported a significant reduction in preterm pre‐eclampsia or perinatal death. Based on the AGREE tools, future statements could use methodological improvement.

Prevention of pre‐eclampsia with aspirin: A systematic review of guidelines and evaluation of the quality of recommendation evidence Journal Articles