The efficacy of low-dose aspirin in pregnancy among women in malaria-endemic countries

Author:

Bauserman Melissa,Leuba Sequoia I.,Hemingway-Foday Jennifer,Nolen Tracy L.,Moore Janet,McClure Elizabeth M.,Lokangaka Adrien,Tsehfu Antoinette,Patterson Jackie,Liechty Edward A.,Esamai Fabian,Carlo Waldemar A.,Chomba Elwyn,Goldenberg Robert L.,Saleem Sarah,Jessani Saleem,Koso-Thomas Marion,Hoffman Matthew,Derman Richard J.,Meshnick Steven R.,Bose Carl L.

Abstract

Abstract Background Low dose aspirin (LDA) is an effective strategy to reduce preterm birth. However, LDA might have differential effects globally, based on the etiology of preterm birth. In some regions, malaria in pregnancy could be an important modifier of LDA on birth outcomes and anemia. Methods This is a sub-study of the ASPIRIN trial, a multi-national, randomized, placebo controlled trial evaluating LDA effect on preterm birth. We enrolled a convenience sample of women in the ASPIRIN trial from the Democratic Republic of Congo (DRC), Kenya and Zambia. We used quantitative polymerase chain reaction to detect malaria. We calculated crude prevalence proportion ratios (PRs) for LDA by malaria for outcomes, and regression modelling to evaluate effect measure modification. We evaluated hemoglobin in late pregnancy based on malaria infection in early pregnancy. Results One thousand four hundred forty-six women were analyzed, with a malaria prevalence of 63% in the DRC site, 38% in the Kenya site, and 6% in the Zambia site. Preterm birth occurred in 83 (LDA) and 90 (placebo) women, (PR 0.92, 95% CI 0.70, 1.22), without interaction between LDA and malaria (p = 0.75). Perinatal mortality occurred in 41 (LDA) and 43 (placebo) pregnancies, (PR 0.95, 95% CI 0.63, 1.44), with an interaction between malaria and LDA (p = 0.014). Hemoglobin was similar by malaria and LDA status. Conclusions Malaria in early pregnancy did not modify the effects of LDA on preterm birth, but modified the effect of LDA on perinatal mortality. This effect measure modification deserves continued study as LDA is used in malaria endemic regions.

Publisher

Springer Science and Business Media LLC

Subject

Obstetrics and Gynecology

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