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Does Adherence Modify Low-Dose Aspirin Effects in Pregnancy? Post Hoc Analysis From a Multi-Centre Trial
Musaku Mwenechanya1, Abigail Mwapule Tembo1, Elwyn Chomba1
1University Teaching Hospital, Lusaka, Zambia.
Summary
Low-dose aspirin (LDA) initiated between 6 and 13 weeks of gestational age (GA) did not significantly impact preterm delivery (PTD) or perinatal mortality. The timing of LDA initiation and adherence did not modify these outcomes in this study.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Clinical Trial Analysis
Background:
- Low-dose aspirin (LDA) is often used in pregnancy to reduce the risk of adverse outcomes.
- The optimal timing for initiating LDA and the impact of adherence on its effectiveness remain areas of investigation.
- This study analyzes data from a large randomized controlled trial conducted in low-resource settings.
Purpose of the Study:
- To determine if the effect of low-dose aspirin (LDA) on preterm delivery (PTD) is modified by the timing of initiation (6-13 weeks gestational age) or by total exposure.
- To evaluate the impact of adherence to LDA treatment on PTD and perinatal mortality.
- To assess potential regional differences in the effect of LDA.
Main Methods:
- Post hoc analysis of a randomized controlled trial involving 11,908 women.
- Women received two-week medication allotments, with adherence assessed by pill counts every two weeks.
- Poisson models were used to estimate risk ratios and confidence intervals for PTD, PTD < 34 weeks, and perinatal mortality, adjusting for site, treatment arm, and gestational age at initiation.
Main Results:
- Initiating LDA between 6 and 13 weeks gestational age showed no significant modification of risk for PTD, PTD < 34 weeks, or perinatal mortality with increasing gestational age at initiation.
- Increased adherence to LDA treatment did not significantly alter the risk ratios for PTD, PTD < 34 weeks, or perinatal mortality.
- No evidence of effect modification was found based on region.
Conclusions:
- The timing of low-dose aspirin initiation between 6 and 13 weeks gestational age does not appear to influence the rates of preterm delivery or perinatal mortality.
- Maternal adherence to low-dose aspirin treatment does not significantly modify its effect on preterm delivery or perinatal mortality.
- These findings suggest that the effectiveness of LDA in this context is not dependent on precise initiation timing or adherence levels.
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