Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Research and Higher Education, Center for Clinical Research, Dalarna, Uppsala University, Falun, Sweden.
Department of Research and Higher Education, Center for Clinical Research, Dalarna, Uppsala University, Falun, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Am J Obstet Gynecol. 2023 Mar;228(3):336.e1-336.e9. doi: 10.1016/j.ajog.2022.09.006. Epub 2022 Sep 9.
Preterm birth is the leading cause of neonatal mortality and morbidity. Women who have had a previous preterm birth are at increased risk for preterm birth in their subsequent pregnancies. Low-dose aspirin use reduces the risk for preterm birth among women at risk of developing preeclampsia, however, it is unclear whether low-dose aspirin may reduce the risk of recurrent preterm birth.
This study aimed to investigate the association between low-dose aspirin use and preterm birth among women with a previous preterm birth.
We conducted a Swedish register-based cohort study and included women who had a first and second pregnancy between 2006 and 2019, with the first pregnancy ending in preterm birth (medically indicated or with spontaneous onset <37 weeks of gestation). The association between low-dose aspirin use and preterm birth in the second pregnancy was estimated via logistic regression via standardization and expressed as marginal relative risks with the 95% confidence interval.
Among the study cohort (N=22,127), 3057 women (14%) were prescribed low-dose aspirin during their second pregnancy and 3703 women (17%) gave birth prematurely. Low-dose aspirin use was associated with a reduced risk for preterm birth, (marginal relative risk, 0.87; 95% confidence interval, 0.77-0.99). There were no statistically significant associations between low-dose aspirin use and an altered risk for moderate preterm birth, defined as birth between 32 and 36 weeks' gestation (marginal relative risk, 0.90; 95% confidence interval, 0.78-1.03), or very preterm birth, defined as birth <32 weeks' gestation (marginal relative risk, 0.75; 95% confidence interval, 0.54-1.04). Regarding the onset of preterm birth, low-dose aspirin use was associated with a reduced risk for spontaneous preterm birth (marginal relative risk, 0.70; 95% confidence interval, 0.57-0.86) but no reduction in the risk for medically indicated preterm birth (marginal relative risk, 1.09; 95% confidence interval, 0.91-1.30) was observed.
Among women with a previous preterm birth, low-dose aspirin use was associated with a reduced risk for preterm birth. When investigating preterm birth by onset in the second pregnancy, low-dose aspirin use was associated with a reduced risk for spontaneous preterm birth. Our results suggest that low-dose aspirin may be an effective prophylaxis for recurrent preterm birth.
早产是新生儿死亡和发病的主要原因。有过早产史的女性在随后的妊娠中早产的风险增加。小剂量阿司匹林的使用降低了子痫前期高危女性早产的风险，然而，小剂量阿司匹林是否可以降低复发性早产的风险尚不清楚。
本研究旨在探讨小剂量阿司匹林的使用与有早产史的女性早产之间的关联。
我们进行了一项瑞典基于登记的队列研究，纳入了 2006 年至 2019 年期间首次和第二次妊娠的女性，第一次妊娠以早产（医学指征或自发早产<37 周）结束。通过标准化的逻辑回归估计第二次妊娠中小剂量阿司匹林的使用与早产之间的关系，并以边际相对风险（95%置信区间）表示。
在研究队列（N=22127）中，3057 名女性（14%）在第二次妊娠中接受了小剂量阿司匹林治疗，3703 名女性（17%）早产。小剂量阿司匹林的使用与早产风险降低相关（边际相对风险，0.87；95%置信区间，0.77-0.99）。小剂量阿司匹林的使用与中度早产（定义为 32 至 36 周之间的分娩）的风险改变之间没有统计学显著关联（边际相对风险，0.90；95%置信区间，0.78-1.03），也与极早产（定义为<32 周的分娩）的风险改变之间没有统计学显著关联（边际相对风险，0.75；95%置信区间，0.54-1.04）。关于早产的发生，小剂量阿司匹林的使用与自发性早产的风险降低相关（边际相对风险，0.70；95%置信区间，0.57-0.86），但对医学指征性早产的风险没有降低（边际相对风险，1.09；95%置信区间，0.91-1.30）。
在有早产史的女性中，小剂量阿司匹林的使用与早产风险降低相关。当在第二次妊娠中通过发病来调查早产时，小剂量阿司匹林的使用与自发性早产的风险降低相关。我们的结果表明，小剂量阿司匹林可能是复发性早产的有效预防措施。
