Sjaarda Lindsey A, Radin Rose G, Silver Robert M, Mitchell Emily, Mumford Sunni L, Wilcox Brian, Galai Noya, Perkins Neil J, Wactawski-Wende Jean, Stanford Joseph B, Schisterman Enrique F
Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland 20892.
Department of Obstetrics and Gynecology, University of Utah and Intermountain Healthcare, Salt Lake City, Utah 84132-2209.
J Clin Endocrinol Metab. 2017 May 1;102(5):1495-1504. doi: 10.1210/jc.2016-2917.
Inflammation is linked to causes of infertility. Low-dose aspirin (LDA) may improve reproductive success in women with chronic, low-grade inflammation.
To investigate the effect of preconception-initiated LDA on pregnancy rate, pregnancy loss, live birth rate, and inflammation during pregnancy.
Stratified secondary analysis of a multicenter, block-randomized, double-blind, placebo-controlled trial.
Four US academic medical centers, 2007 to 2012.
Healthy women aged 18 to 40 years (N = 1228) with one to two prior pregnancy losses actively attempting to conceive.
Preconception-initiated, daily LDA (81 mg) or matching placebo taken up to six menstrual cycles attempting pregnancy and through 36 weeks' gestation in women who conceived.
Confirmed pregnancy, live birth, and pregnancy loss were compared between LDA and placebo, stratified by tertile of preconception, preintervention serum high-sensitivity C-reactive protein (hsCRP) (low, <0.70 mg/L; middle, 0.70 to <1.95 mg/L; high, ≥1.95 mg/L).
Live birth occurred in 55% of women overall. The lowest pregnancy and live birth rates occurred among the highest hsCRP tertile receiving placebo (44% live birth). LDA increased live birth among high-hsCRP women to 59% (relative risk, 1.35; 95% confidence interval, 1.08 to 1.67), similar to rates in the lower and mid-CRP tertiles. LDA did not affect clinical pregnancy or live birth in the low (live birth: 59% LDA, 54% placebo) or midlevel hsCRP tertiles (live birth: 59% LDA, 59% placebo).
In women attempting conception with elevated hsCRP and prior pregnancy loss, LDA may increase clinical pregnancy and live birth rates compared with women without inflammation and reduce hsCRP elevation during pregnancy.
炎症与不孕原因有关。低剂量阿司匹林（LDA）可能会提高患有慢性低度炎症女性的生殖成功率。
研究孕前开始使用LDA对妊娠率、流产率、活产率及孕期炎症的影响。
对一项多中心、区组随机、双盲、安慰剂对照试验进行分层二次分析。
美国四个学术医疗中心，2007年至2012年。
年龄在18至40岁之间的健康女性（N = 1228），有一至两次既往流产史，积极尝试受孕。
孕前开始每日服用LDA（81毫克）或匹配的安慰剂，持续六个月经周期以尝试受孕，对于成功受孕的女性则持续至妊娠36周。
比较LDA组和安慰剂组之间的确诊妊娠、活产和流产情况，按孕前、干预前血清高敏C反应蛋白（hsCRP）三分位数分层（低，<0.70毫克/升；中，0.70至<1.95毫克/升；高，≥1.95毫克/升）。
总体上55%的女性活产。在接受安慰剂的hsCRP三分位数最高组中，妊娠率和活产率最低（活产率44%）。LDA将高hsCRP女性的活产率提高至59%（相对风险，1.35；95%置信区间，1.08至1.67），与低和中CRP三分位数组的比率相似。LDA对低hsCRP三分位数组（活产率：LDA组59%，安慰剂组54%）或中hsCRP三分位数组（活产率：LDA组59%，安慰剂组59%）的临床妊娠或活产没有影响。
对于hsCRP升高且有既往流产史的受孕女性，与无炎症的女性相比，LDA可能会提高临床妊娠率和活产率，并降低孕期hsCRP升高水平。
