An important study showing that low-dose aspirin (LDA) 81 mg/day can increase fertility and successful pregnancy in women with mild chronic inflammation and prior miscarriage. Chronic inflammation is documented by elevated hsCRP.
A clinical implication could be checking hsCRP in women with history of pregnancy loss, and if elevated to prescribe low-dose aspirin. LDA has been found safe during pregnancy, while full-dose aspirin should be avoided during the third trimester.
J C E M
Context: Inflammation is linked to causes of infertility. Low-dose aspirin (LDA) may improve reproductive success in women with chronic, low-grade inflammation.
Objective: To investigate the effect of preconception-initiated LDA on pregnancy rate, pregnancy loss, live birth rate, and inflammation during pregnancy.
Design: Stratified secondary analysis of a multicenter, block-randomized, double-blind, placebo-controlled trial.
Setting: Four US academic medical centers, 2007 – 2012.
Participants: Healthy women aged 18-40 years (N = 1228) with 1-2 prior pregnancy losses actively attempting to conceive.
Intervention: Preconception-initiated, daily LDA (81 mg) or matching placebo taken up to 6 menstrual cycles attempting pregnancy and through 36 weeks’ gestation in women who conceived.
Main Outcome Measures: Confirmed pregnancy, live birth, and pregnancy loss were compared between LDA and placebo, stratified by tertile of preconception, preintervention serum hsCRP (low, <0.70 mg/L; middle, 0.70-1.95 mg/L; high, ≥1.95 mg/L).
Results: 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 benefit, 1.35; P<0.05), 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).
Conclusions: 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.