Preconception Low-Dose Aspirin Restores Diminished Pregnancy and Live Birth Rates in Women With Low-Grade Inflammation: A Secondary Analysis of a Randomized Trial.
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.
Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland 20892.
Lindsey A
LA
Sjaarda
Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland 20892.
Rose G
RG
Radin
Department of Obstetrics and Gynecology, University of Utah and Intermountain Healthcare, Salt Lake City, Utah 84132-2209.
Robert M
RM
Silver
Centers for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland 20857.
Emily
E
Mitchell
Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland 20892.
Sunni L
SL
Mumford
Department of Clinical Sciences, Obstetrics and Gynecology, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania 18509.
Brian
B
Wilcox
Department of Statistics, University of Haifa, Haifa 3498838, Israel.
Noya
N
Galai
Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland 20892.
Neil J
NJ
Perkins
Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York 14214-8001.
Jean
J
Wactawski-Wende
Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah 84108.
Joseph B
JB
Stanford
Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland 20892.
Enrique F
EF
Schisterman
D000022:Abortion, Spontaneous / Q000453:epidemiology*; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage*; D001723:Birth Rate; D002097:C-Reactive Protein / Q000276:immunology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007249:Inflammation / Q000188:drug therapy* / Q000276:immunology; D050498:Live Birth / Q000453:epidemiology*; D016742:Preconception Care / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D055815:Young Adult
D000894:Anti-Inflammatory Agents, Non-Steroidal; D002097:C-Reactive Protein; D001241:Aspirin