PMID- 35399060 OWN - NLM STAT- MEDLINE DCOM- 20220412 LR - 20231125 IS - 1471-2393 (Electronic) IS - 1471-2393 (Linking) VI - 22 IP - 1 DP - 2022 Apr 10 TI - The efficacy of low-dose aspirin in pregnancy among women in malaria-endemic countries. PG - 303 LID - 10.1186/s12884-022-04652-9 [doi] LID - 303 AB - 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. CI - (c) 2022. The Author(s). FAU - Bauserman, Melissa AU - Bauserman M AD - University of North Carolina at Chapel Hill, Chapel Hill, Chapel Hill, NC, USA. melissa_bauserman@med.unc.edu. FAU - Leuba, Sequoia I AU - Leuba SI AD - University of North Carolina at Chapel Hill, Chapel Hill, Chapel Hill, NC, USA. FAU - Hemingway-Foday, Jennifer AU - Hemingway-Foday J AD - RTI International, Durham, NC, USA. FAU - Nolen, Tracy L AU - Nolen TL AD - RTI International, Durham, NC, USA. FAU - Moore, Janet AU - Moore J AD - RTI International, Durham, NC, USA. FAU - McClure, Elizabeth M AU - McClure EM AD - RTI International, Durham, NC, USA. FAU - Lokangaka, Adrien AU - Lokangaka A AD - Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo. FAU - Tsehfu, Antoinette AU - Tsehfu A AD - Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo. FAU - Patterson, Jackie AU - Patterson J AD - University of North Carolina at Chapel Hill, Chapel Hill, Chapel Hill, NC, USA. FAU - Liechty, Edward A AU - Liechty EA AD - Indiana University School of Medicine, University of Indiana, Indianapolis, IN, USA. FAU - Esamai, Fabian AU - Esamai F AD - Moi University School of Medicine, Eldoret, Kenya. FAU - Carlo, Waldemar A AU - Carlo WA AD - University of Alabama at Birmingham, Birmingham, AL, USA. FAU - Chomba, Elwyn AU - Chomba E AD - University Teaching Hospital, Lusaka, Zambia. FAU - Goldenberg, Robert L AU - Goldenberg RL AD - Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA. FAU - Saleem, Sarah AU - Saleem S AD - Aga Khan University, Karachi, Pakistan. FAU - Jessani, Saleem AU - Jessani S AD - Aga Khan University, Karachi, Pakistan. FAU - Koso-Thomas, Marion AU - Koso-Thomas M AD - Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA. AD - Department of Obstetrics and Gynecology, Christiana Care, Newark, DE, USA. FAU - Hoffman, Matthew AU - Hoffman M AD - Department of Obstetrics and Gynecology, Christiana Care, Newark, DE, USA. FAU - Derman, Richard J AU - Derman RJ AD - Thomas Jefferson University, Philadelphia, USA. FAU - Meshnick, Steven R AU - Meshnick SR AD - University of North Carolina at Chapel Hill, Chapel Hill, Chapel Hill, NC, USA. FAU - Bose, Carl L AU - Bose CL AD - University of North Carolina at Chapel Hill, Chapel Hill, Chapel Hill, NC, USA. LA - eng GR - UG1 HD076465/HD/NICHD NIH HHS/United States PT - Journal Article PT - Randomized Controlled Trial DEP - 20220410 PL - England TA - BMC Pregnancy Childbirth JT - BMC pregnancy and childbirth JID - 100967799 RN - R16CO5Y76E (Aspirin) SB - IM MH - Aspirin/therapeutic use MH - Female MH - Humans MH - Infant, Newborn MH - *Malaria/drug therapy/epidemiology/prevention & control MH - *Perinatal Death MH - Perinatal Mortality MH - Pregnancy MH - Pregnancy Outcome/epidemiology MH - *Premature Birth/drug therapy/epidemiology/prevention & control PMC - PMC8994890 OTO - NOTNLM OT - Malaria OT - Perinatal mortality OT - Pregnancy OT - Premature birth COIS- The authors declare that they have no competing interests. EDAT- 2022/04/12 06:00 MHDA- 2022/04/13 06:00 PMCR- 2022/04/10 CRDT- 2022/04/11 05:03 PHST- 2021/08/11 00:00 [received] PHST- 2022/03/23 00:00 [accepted] PHST- 2022/04/11 05:03 [entrez] PHST- 2022/04/12 06:00 [pubmed] PHST- 2022/04/13 06:00 [medline] PHST- 2022/04/10 00:00 [pmc-release] AID - 10.1186/s12884-022-04652-9 [pii] AID - 4652 [pii] AID - 10.1186/s12884-022-04652-9 [doi] PST - epublish SO - BMC Pregnancy Childbirth. 2022 Apr 10;22(1):303. doi: 10.1186/s12884-022-04652-9.