Insight Into Aspirin's Therapeutic Effect On Higher Risk Pregnancies
Lindsey Sjaarda, Ph.D, NICHD Division of Intramural and Population Health Research
Giving aspirin in the months prior to conception has been shown to help mothers suffering from chronic inflammation conceive. These findings were published in the Effects of Aspirin in Gestation and Reproduction (EAGeR) trial which studied 1078 mothers that had previously experienced one or two pregnancy losses (Schisterman et al. 2014).
A secondary analysis of this data set better describes the level of inflammation at which intervention with low-dose aspirin becomes therapeutically beneficial. The level of inflammation is measured as the level of C-reactive protein (CRP), a marker of system-wide inflammation. In the group of women with a high level of CRP (above 1.95mg per litre of blood), low-dose aspirin taken in the months prior to conception and during pregnancy, reduced CRP levels and increased the live-birth rate by 35% compared to those treated with a placebo.
I asked lead author of the secondary study, Dr. Lindsey Sjaarda, staff scientist at the National Institute of Child Health and Human Development Division of Intramural and Population Health Research, some questions about the findings.
AT: What prompted you to study the effect of aspirin on pregnancy in these women?
LS: Since aspirin is known for its effects on reducing inflammation and promoting blood flow, and it has been studied in patients undergoing in vitro fertilization with some studies showing positive effects. Therefore, our team wanted to examine whether using aspirin in women trying to becoming pregnant without fertility treatment may potentially be of benefit.
AT: How well was the aspirin tolerated, were there any side effects?
LS: We have a published paper (Ahrens et al. 2016) addressing all the side effect information that was carefully assessed throughout the trial, and that shows us that while there was greater bleeding (for example, vaginal bleeding) in the aspirin group, there were not any effects on miscarriage risk or other complications. Generally, it was well tolerated.
AT: Are there any other candidate drugs that could further improve outcomes for would-be-mothers with chronic inflammation?
LS: There are no such drugs that have been tested at this time, but it’s a promising area of research as we learn more about the role of inflammation in becoming pregnant and learn more about other drugs with anti-inflammatory effects that may have an application in this area one day.
AT: Could this treatment help women suffering from autoimmune conditions conceive?
LS: Women with autoimmune conditions were specifically excluded from our study, as we were focusing on healthy women trying to conceive after a history of pregnancy loss. Therefore, we can’t comment on whether low dose aspirin could have any effect in women with these types of conditions.
AT: Did you get any feedback from the mothers that were able to conceive and carry their babies to term? If so, what did they say? Would they recommend the treatment?
LS: We did not formally collect any feedback from the mothers, though most participants were very excited about participating and sent many positive thoughts and messages in notes to study staff after their participation. Participants were asked afterward whether they suspected they were taking the intervention (aspirin) as opposed to placebo, and more often mothers who conceived and carried their babies to term guessed they were taking the aspirin.
AT: Was there any follow-up on the health of the babies?
LS: To date, there has not been follow-up of the babies born in this trial, but options for future follow-up in these children are being explored.
Lindsey Sjaarda, Ph.D was talking to Adam Tozer, Ph.D, Science Writer at www.TechnologyNetworks.com
Ahrens, K.A., Silver, R.M., Mumford, S.L., Sjaarda, L.A., Perkins, N.J., Wactawski-Wende, J., Galai, N., Townsend, J.M., Lynch, A.M., Lesher, L.L., Faraggi, D., Zarek, S. and Schisterman, E.F. (2016) ‘Complications and safety of Preconception low-dose aspirin among women with prior pregnancy losses’, Obstetrics & Gynecology, 127(4), pp. 689–698.
Schisterman, E.F., Silver, R.M., Lesher, L.L., Faraggi, D., Wactawski-Wende, J., Townsend, J.M., Lynch, A.M., Perkins, N.J., Mumford, S.L. and Galai, N. (2014) ‘Preconception low-dose aspirin and pregnancy outcomes: Results from the eAGeR randomised trial’, The Lancet, 384(9937), pp. 29–36.
Sjaarda, LA, Radin, R.G., Silver, R.M., Mitchell, E., Mumford, S.L., Wilcox, B., Galai, Noya., Perkins, N.J., Wactawski-Wende, J., Stanford, J.B., Schisterman, E.F., Preconception low-dose aspirin restores diminished pregnancy and live birth rates in women with low grade inflammation: a secondary analysis of a randomized trial. 2017 JCEM.2016-2917.