Background: The results of randomized controlled studies on aspirin for the prevention of preeclampsia (PE) are conflicting, and some of the related meta-analyses also have limitations or flaws.Data sources: A search was conducted on PubMed, Embase, and Cochrane Central Register of Controlled Trials databases, with no time or language restrictions.Study eligibility criteria: Randomized controlled studies comparing aspirin for the prevention of PE were conducted.Methods: Systematic reviews were performed according to the Cochrane Manual guidelines. A fixed-effects model or a random-effects model was chosen to calculate pooled relative risks with 95% confidence intervals based on the heterogeneity of the included studies. The study aimed to investigate the effect of aspirin on the development of PE in high-risk and general populations of women. Publication bias was assessed by funnel plots. All included studies were assessed for bias by the Cochrane Manual of Bias Assessment. Subgroup analyses were conducted on the aspirin dose, time of initial aspirin intervention, and the region in which the research was conducted, to explore the effective dose of aspirin and time of initial aspirin intervention and to try to find sources of heterogeneity and publication bias.Results: A total of 39 articles were included, including 29 studies involving pregnant women at high risk for PE (20,133 patients) and 10 studies involving a general population of pregnant women (18,911 patients). Aspirin reduced the incidence of PE by 28% (RR 0.72, 95% CI 0.62–0.83) in women at high risk for PE. Aspirin reduced the incidence of PE by 30% in the general population (RR 0.70, 95% CI 0.52–0.95), but sensitivity analyses found that aspirin in the general population was not robust. A subgroup analysis showed that an aspirin dose of 75 mg/day (RR 0.50, 95% CI 0.32–0.78) had a better protective effect than other doses. Starting aspirin at 12–16 weeks (RR 0.62, 95% CI 0.53–0.74) of gestation or 17–28 weeks (RR 0.62, 95% CI 0.44–0.89) reduced the incidence of PE by 38% in women at high risk for PE, but the results were more reliable for use at 12–16 weeks. Heterogeneity and publication bias of the included studies may be mainly due to the studies completed in Asia.Conclusion: Aspirin is recommended to be started at 12–16 weeks of pregnancy in women at high risk for PE. The optimal dose of aspirin to use is 75 mg/d.Systematic review registration: [www.ClinicalTrials.gov], identifier [CRD42022319984].

The aim of this study was to determine whether the increased serum cell-free fetal DNA (cffDNA) level of gravidas developed into early-onset preeclampsia (EOPE) subsequently in the early second trimesters is related to prenatal screening markers. Serum was collected from 1011 gravidas. The level of cffDNA and prenatal screening markers were analyzed in 20 cases with EOPE and 20 controls. All fetuses were male. The maternal serum cffDNA level was assessed by amplification of the Y chromosome specific gene. Correlations between the variables were examined. (Logged) cffDNA in EOPE (median, 3.08; interquartile range, 2.93–3.68) was higher than controls (median, 1.79; interquartile range, 1.46–2.53). The increased level of (logged) cffDNA was correlated significantly with the increased human chorionic gonadotropin (HCG) level (r = 0.628, p < 0.001). Significant reciprocal correlations between cffDNA and babies’ birth weight as well as gestation weeks at delivery were noted (r = −0.516, p = 0.001; r = −0.623, p < 0.001, respectively). The sensitivity and specificity of cffDNA to discriminate between the EOPE cases and the controls were 90% and 85%, respectively. CffDNA is a potential marker for EOPE, which had a significant reciprocal correlation with babies’ birth weight and gestation weeks at delivery. Moreover, it may help in indicating the underlying hypoxic condition in the placenta.

Objective: To evaluate the efficacy of cervical pessary in the prevention of preterm birth and its influence on pregnancy and maternal outcomes, so as to provide a clinical basis for cervical pessary to prevent premature delivery. Methods: The databases of PubMed, Web of Science, CNKI, WanFang Data, etc, were used to search for the eligible articles. The relevant data were abstracted by two independent reviewers and performed with Stata 12.0. Results: Pregnancy Result: the PTB rates of pessary and control group before 28, 32, 34, and 37 weeks were analyzed and the combined RR (95%CI) values were 0.78 (0.46, 1.31), 0.92 (0.67, 1.28), 0.74 (0.49, 1.13), and 0.79 (0.54, 1.15). Compared with the control group, the utilization rate of tocolytic and corticosteroids was decreased 21% (RR = 0.79, 95%CI = 0.66–0.94) and 18% (RR = 0.82, 95%CI = 0.70–0.96). The risk of PROM and the difference was not statistically significant (p > .05). Subgroup analysis showed that there was no significant difference on the PTB rate subgroup and twins subgroup during 28 and 34 weeks (p > .05). The results showed that there was no significant difference on neonatal weight <1500 g and .05). Three articles on the average gestational age were included in the cervical length .05). Conclusions: Compared with expectant management, pessary could prolong pregnancy and reduce the rate of tocolysis and corticosteroids. More registered trials are ongoing which may substantially change our results.

Objective: The aim of this study is to investigate whether certain combination of maternal killer cell immunoglobulin-like receptors (KIR) and fetal human leukocyte antigen-C (HLA-C) is risk for preeclampsia in the Chinese Han population. Methods: A case–control study was conducted in 47 pregnant women with preeclampsia and 54 normal pregnant women. Twelve KIR genes were genotyped by PCR-sequence-specific primer in mothers. High-resolution HLA-C genotyping was performed in couples and fetuses by a routine sequencing-based typing method. Results: The frequency of KIR2DS1 was decreased (p = 0.028) and AA genotype was increased (p = 0.017) in preeclampsia compared with controls. More women with KIR AA genotype have fewer C2 genes than their fetuses in preeclampsia than controls. Conclusion: Women with KIR AA genotype and fewer C2 genes than their fetuses were at risk for preeclampsia in the Chinese Han population, supporting that maternal–fetal KIR-HLA-C interaction plays an important role in preeclampsia development.