Aspirin delays the onset of hypertensive disorders of pregnancy among nulliparous pregnant women: A secondary analysis of the ASPIRIN trial
Year: 2023
Type: article
Abstract: OBJECTIVE: To assess the impact of low-dose aspirin (LDA) starting in early pregnancy on delaying preterm hypertensive disorders of pregnancy. DESIGN: Non-prespecified secondary analysis of a randomised masked trial of LDA. SETTING: The study was conducted among women in the Global Network for Women's and Children's Health's Maternal and Newborn Health Registry (MNHR) clusters, a prospective, population-based study in Kenya, Zambia, the Democratic Republic of the Congo (DRC), Pakistan, India (two sites-Belagavi and Nagpur) and Guatemala. POPULATION: weeks in six low-middle income countries (Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, Zambia) enrolled in the ASPIRIN Trial. METHODS: We compared the incidence of HDP at delivery at three gestational age periods (<28, <34 and <37 weeks) between women who were randomised to aspirin or placebo. Women were included if they were randomised and had an outcome at or beyond 20 weeks (Modified Intent to Treat). MAIN OUTCOME MEASURES: Our primary outcome was pregnancies with HDP associated with preterm delivery (HDP@delivery) before <28, <34 and <37 weeks. Secondary outcomes included small for gestational age (SGA) <10th percentile, <5th percentile, and perinatal mortality. RESULTS: Among the 11 976 pregnancies, LDA did not significantly lower HDP@delivery <28 weeks (relative risk [RR] 0.18, 95% confidence interval [CI] 0.02-1.52); however, it did lower HDP@delivery <34 weeks (RR 0.37, 95% CI 0.17-0.81) and HDP@delivery <37 weeks (RR 0.66, 95% CI 0.49-0.90). The overall rate of HDP did not differ between the two groups (RR 1.08, 95% CI 0.94-1.25). Among those pregnancies who had HDP, SGA <10th percentile was reduced (RR 0.81, 95% CI 0.67-0.99), though SGA <5th percentile was not (RR 0.84, 95% CI 0.64-1.09). Similarly, perinatal mortality among pregnancies with HDP occurred less frequently (RR 0.55, 95% CI 0.33-0.92) in those receiving LDA. Pregnancies randomised to LDA delivered later with HDP compared with those receiving placebo (median gestational age 38.5 weeks vs. 37.9 weeks; p = 0.022). CONCLUSIONS: In this secondary analysis of a study of low-risk nulliparous singleton pregnancies, early administration of LDA resulted in lower rates of preterm HDP and delivery before 34 and 37 weeks but not in the overall rate of HDP. These results suggest that LDA works in part by delaying HDP.
Authors: Avinash Kavi, Matthew K. Hoffman, Manjunath S. Somannavar, Mrityunjay C. Metgud, Shivaprasad S. Goudar, Janet Moore, Eleanor Nielsen, Norman Goco, Elizabeth M. McClure, Adrien Lokangaka, Antoinette Tshefu, Melissa Bauserman, Musaku Mwenechanya, Elwyn Chomba, Waldemar A. Carlo, Lester Figueroa, Nancy F. Krebs, Saleem Jessani, Sarah Saleem, Robert L. Goldenberg, Prabirkumar Das, Archana Patel, Patricia L. Hibberd, Fabian Esamai, Sherri Bucher, Marion Koso‐Thomas, Robert Silver, Richard J. Derman
Institutions: Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, RTI International, Ecole de santé publique de Kinshasa, University of North Carolina at Chapel Hill, University Teaching Hospital, University of Alabama at Birmingham, Institute of Nutrition of Central America and Panama, University of Colorado Anschutz, University of Colorado Denver, Aga Khan University, Columbia University, Lata Medical Research Foundation, Datta Meghe Institute of Higher Education and Research, Boston University, Moi University, Indiana University Indianapolis, Indiana University School of Medicine, Eunice Kennedy Shriver National Institute of Child Health and Human Development, University of Utah, Thomas Jefferson University
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,940
Awards: G1472282359, The Global Network and Preconception Maternal Nutrition, Global Network for Women's & Children's Health Research Data Coordinating Center, G472522141, G5426933423, CCHS-JNMC Global Network for Women's & Children's Health Research Unit, The University of North Carolina-Kinshasa School of Public Health Research Partnership in the Democratic Republic of Congo; a Model for Improving Women's and Children's Health Through Research, Global Network for Women's and Children's Health Research Data Coordinating Center
OpenAlex ID: W4384820743