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Abstract
Objective: To assess the role of low-dose aspirin (75 mg) in preventing spontaneous preterm birth among high-risk pregnant women in Pakistan.
Methods: This quasi-experimental study was conducted at the Department of Obstetrics and Gynecology, Railway General Hospital, Rawalpindi, from August 2023 to August 2024. This study received formal ethical approval from the institutional review committee of Islamic International Medical College Rawalpindi, approval number IRC/23/3087. The study was conducted in strict adherence to the institutionally approved protocol and the ethical standards of the Declaration of Helsinki. A total of 250 pregnant women with a previous history of preterm birth were recruited at 12-15 weeks of gestation through consecutive sampling. Participants were allocated to two parallel groups based on the clinical intervention schedule. Group A received aspirin 75mg daily with folic acid and standard preventive therapies, while Group B received folic acid and routine preventive measures only. Outcomes included incidence of preterm delivery before 34 weeks and neonatal birth weight. Data were analysed using SPSS version 26. Statistical significance was set at p < 0.05. The baseline demographic and clinical characteristics of both groups were compared to ensure comparability. The normality of all continuous variables, including maternal age and birth weight, was verified using the Shapiro-Wilk test and visual inspection of Q-Q plots. Data following a normal distribution were summarised as mean(SD). Intergroup comparisons for categorical outcomes were performed using the chi-square test.
Results: Preterm birth before 34 weeks occurred in 5.6% (7/125) of women in the aspirin group compared to 14.4% (18/125) in the control group (p[P1.1]=0.02; RD:8.8%, 95% CI:1.6-16.0%). Low birth weight (< 2500 g) was observed in 32% of neonates in the aspirin group versus 48% in the control group (p= 0.014). Mild adverse effects of aspirin, such as epigastric pain and allergic reactions, were reported in 8.8% (11/125) of participants in the intervention group.
Conclusion: Low-dose aspirin (75 mg) initiated in early pregnancy significantly reduces the risk of spontaneous preterm birth and improves neonatal outcomes in high-risk women. Its use is recommended as an affordable preventive strategy in resource-limited settings.
Keywords: Aspirin; Premature Birth; Chemoprevention; Pregnancy; High-risk; Infant; Premature.
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