Low-dose aspirin reduces risk for preterm birth in first-time moms
Taking low-dose aspirin as early as 6 weeks’ gestation could reduce the risk for preterm birth among first-time mothers, according to results from a randomized clinical trial published in The Lancet.
“Prematurity is a primary driver of newborn morbidity and mortality, both in the U.S. and worldwide,” Mathew K. Hoffman, MD, the Marie E. Pinizzotto, MD, Endowed Chair of Obstetrics and Gynecology for Christiana Care Health System, told Healio Primary Care. “Children born preterm are more likely to have long-term health problems and learning challenges than children born at term.”
Previously, studies on the use of low-dose aspirin to prevent preeclampsia in pregnant women found that besides reducing the risk for preeclampsia, it also lowered the risk for preterm birth.
The Aspirin Supplementation for Pregnancy Indicated risk Reduction In Nulliparas, or ASPIRIN, trial, was a multinational, randomized, double-masked, placebo-controlled trial that ran from Mar. 23, 2016, to June 30, 2018, at sites in India, Pakistan, Zambia, the Democratic Republic of the Congo, Guatemala and Kenya. Pregnant women aged 14 to 40 years who had not previously given birth were recruited at hospital-based clinics and primary health care centers.
Those eligible for the study were randomly assigned to receive 81 mg of aspirin daily or placebo through 36 weeks and 7 days of gestation or until delivery.
Researchers said the primary outcome — the incidence of preterm birth, or birth before 37 weeks’ gestational age — was evaluable in 5,780 women who took low-dose aspirin and 5,764 who received placebo.
Preterm birth prior to 37 weeks’ gestation occurred in 11.6% of the aspirin group and in 13.1% of the placebo group (RR = 0.89; 95% CI, 0.81-0.98).
Compared with the placebo group, the aspirin group had significant decreases in perinatal mortality (RR = 0.86; 95% CI, 0.73-1), fetal loss after 16 weeks gestation or up to 7 days after birth (RR = 0.86; 95% CI, 0.74-1), delivery before 34 weeks gestation (RR = 0.75; 95% CI, 0.61-0.93) and delivery before 34 weeks in women with pregnancy hypertensive disorders (RR = 0.38; 95% CI, 0.17-0.85).
The occurrence of serious adverse events — including maternal bleeding complications, anemia, maternal deaths, congenital anomalies and neonatal deaths — were similar between both groups.
“This study demonstrates that low-dose aspirin reduces the risk of preterm birth prior to 37 weeks (11%), preterm birth prior to 34 weeks (25%) and perinatal mortality (14%),” Hoffman said. “This intervention is low-cost and was not associated with an increase in side effects.”
He explained that shared decision-making between providers and women is essential, and the benefits of taking low-dose aspirin during pregnancy identified in the study suggest that “providers should be having this discussion,” with their patients. – by Erin Michael
Disclosures: The authors report no relevant financial disclosures.