The effects of low-dose aspirin on preterm birth: a systematic review and meta-analysis of randomized controlled trials.

AIM: To conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) that evaluated the efficacy of low-dose aspirin (LDA, ≤ 160 mg/day) on preventing preterm birth (PB). METHODS: Five databases were screened from inception until June 25, 2023. The RCTs were assessed for quality according to Cochrane's risk of bias tool. The endpoints were summarized as risk ratio (RR) with 95% confidence interval (CI). RESULTS: Overall, 40 RCTs were analyzed. LDA significantly decreased the risk of PB < 37 weeks (RR: 0.91, 95% CI 0.87, 0.96, p < 0.001, moderate certainty of evidence) with low between-study heterogeneity (I2 = 23.2%, p = 0.11), and PB < 34 weeks (RR: 0.78, 95% CI 0.61, 0.99, p = 0.04, low certainty of evidence) with high between-study heterogeneity (I2 = 58.3%, p = 0.01). There were no significant differences between both groups regarding the risk of spontaneous (RR: 0.94, 95% CI 0.83, 1.07, p = 0.37) and medically indicated (RR: 1.28, 95% CI 0.87, 1.88, p = 0.21) BP < 37 weeks. Sensitivity analysis revealed robustness for all outcomes, except for the risk of PB < 34 weeks. For PB < 37 weeks and PB < 34 weeks, publication bias was detected based on visual inspection of funnel plots for asymmetry and statistical significance for Egger's test (p = 0.009 and p = 0.0012, respectively). CONCLUSION: LDA can significantly reduce the risk of PB < 37 and < 34 weeks. Nevertheless, further high-quality RCTs conducted in diverse populations, while accounting for potential confounding factors, are imperative to elucidate the optimal aspirin dosage, timing of initiation, and treatment duration for preventing preterm birth and to arrive at definitive conclusions.

Effect of hidradenitis suppurativa on obstetric and neonatal outcomes.

PURPOSE: Hidradenitis suppurativa (HS) is a debilitating chronic inflammatory skin disease with an often-unsatisfactory response to treatment. The objective was to evaluate the association between HS and pregnancy, delivery and neonatal outcomes. METHODS: The United States' Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database was used to conduct a retrospective cohort study among all women who delivered between 1999 and 2015. ICD-9 code 705.83 identified those with HS, with the remaining deliveries composing the comparison group. Multivariate logistic regression compared maternal and neonatal outcomes between these two groups, while adjusting for baseline maternal variables. RESULTS: The study included 13,792,544 deliveries, of which 1021 were associated with an HS diagnosis (7.4/100,000 deliveries). During the observation period, there was an upward trend in the prevalence of HS among pregnant women (<0.0001). Pregnant women with HS were more likely to be African-American, to belong to a lower income quartile, and to be insured by Medicaid. They were also more likely to smoke, to be morbidly obese, and to be hypertensive. Compared with women without HS, those with HS had a greater likelihood of developing preeclampsia (OR 1.36, 95% CI 1.08-1.71), delivering by cesarean section (OR 1.78, 95% CI 1.56-2.02), and having a baby with congenital anomalies (OR 2.00, 95% CI 1.10-3.62). CONCLUSIONS: Although HS is a complex skin disorder, pregnancies complicated by HS had comparable outcomes to non-HS pregnancies, with the exception of a greater risk of preeclampsia, cesarean sections, and congenital anomalies. Health-care providers and women should be aware of these HS associated risks.