ESPEYB17 14. The Year in Science and Medicine (1) (16 abstracts)
14.10. Low-dose aspirin for the prevention of preterm delivery
Hoffman MK , Goudar SS , Kodkany BS , Metgud M , Somannavar M , Okitawutshu J , Lokangaka A , Tshefu A , Bose CL , Mwapule A , Mwenechanya M , Chomba E , Carlo WA , Chicuy J , Figueroa L , Garces A , Krebs NF , Jessani S , Zehra F , Saleem S , Goldenberg RL , Kurhe K , Das P , Patel A , Hibberd PL , Achieng E , Nyongesa P , Esamai F , Liechty EA , Goco N , Hemingway-Foday J , Moore J , Nolen TL , McClure EM , Koso-Thomas M , Miodovnik M , Silver R , Derman RJ & ASPIRIN Study Group
To read the full abstract: Lancet. 2020 Jan 25;395(10220):285-293. doi: 10.1016/S0140-6736(19)32973-3.
This randomised, placebo-controlled trial (‘ASPIRIN’) in 11,976 nulliparous women in six low or middle-income countries (India, Democratic Republic of the Congo, Guatemala, Kenya, Pakistan, and Zambia) found that low-dose aspirin (81 mg daily from early pregnancy) reduced the risk of preterm delivery (before 37 weeks gestational age) to 11.6% compared to 13.1% in controls (Relative Risk 0.89 [95% CI 0.81 to 0.98], P =0.012). There were also significant reductions in perinatal mortality (0.86, p=0.048), fetal loss (0.86, P =0.039), early preterm delivery (<34 weeks (0.75, P =0.039), and early preterm delivery with hypertensive disorders of pregnancy (0.38 [0.17–0.85], P =0.015).
Preterm birth is the leading cause of newborn mortality and childhood disability. Hence, any intervention to avoid preterm delivery has huge potential for clinical and socio-economic benefits. This trial tested the hypothesis that low-dose aspirin would prevent preterm delivery by reducing mechanisms related to pre-eclampsia during early pregnancy placentation and spiral artery formation. The findings are consistent with that premise, as a larger effect was seen particularly for early preterm delivery associated with hypertensive disorders of pregnancy, while the relatively modest overall effect on preterm delivery may suggest that other mechanisms are unaffected. It would be interesting to explore how much this mechanism, and its modification by low-dose aspirin, contributes to preterm delivery in high income populations.
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ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
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