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Low-dose aspirin and preterm birth: a randomized controlled trial.

Robert M Silver1, Katherine Ahrens, Luchin F Wong

  • 1Departments of Obstetrics and Gynecology, University of Utah Health Sciences Center and Intermountain Health Care, Salt Lake City, Utah, and University of Colorado, Aurora, Colorado; the Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; the Department of Statistics, University of Haifa, Mt. Carmel, Haifa, Israel; the Department of Social and Preventive Medicine, University at Buffalo, Buffalo, New York; the Department of Family, Community and Rural Health, Commonwealth Medical College, Scranton, Pennsylvania.

Obstetrics and Gynecology
|March 10, 2015
PubMed
Summary

Preconception low-dose aspirin did not significantly reduce preterm birth rates in a secondary analysis. However, trends suggest potential benefits for women with a recent early pregnancy loss, meriting further research.

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Area of Science:

  • Reproductive Medicine
  • Maternal-Fetal Medicine
  • Clinical Pharmacology

Background:

  • Preterm birth remains a leading cause of neonatal morbidity and mortality.
  • Identifying effective interventions to prevent preterm birth is a critical public health priority.
  • The role of preconception interventions, such as low-dose aspirin, requires further elucidation.

Purpose of the Study:

  • To investigate the association between preconception low-dose aspirin initiation and the risk of preterm birth.
  • To analyze secondary outcomes from a randomized controlled trial evaluating aspirin's effects on pregnancy.

Main Methods:

  • Secondary analysis of the Effects of Aspirin in Gestation and Reproduction trial.
  • Randomized controlled trial involving women with a history of pregnancy loss.
  • Participants received daily low-dose aspirin (81 mg) with folic acid or folic acid alone (placebo).
  • Intent-to-treat analysis was used to compare preterm birth rates between groups.

Main Results:

  • Overall preterm birth rates were not significantly different between the low-dose aspirin and placebo groups (RR 0.72, 95% CI 0.42-1.23).
  • Subgroup analyses, particularly in confirmed pregnancies with a recent single early loss, showed a numerically lower rate of preterm birth in the aspirin group (RR 0.39, 95% CI 0.16-0.94).
  • The study was underpowered to detect statistically significant differences for this secondary outcome.

Conclusions:

  • Preconception low-dose aspirin was not significantly associated with a reduced overall rate of preterm birth.
  • Emerging trends suggest a potential benefit in specific subgroups, particularly women with a history of early pregnancy loss.
  • Further adequately powered studies are warranted to confirm these findings and explore targeted interventions.