Abstract
Background The rate of preterm births in Germany is 8.6%, which is very high compared to other
European countries. As preterm birth contributes significantly to perinatal morbidity
and mortality rates, the existing prevention strategies need to be optimized and expanded
further. About ⅔ of all women with preterm birth have preterm labor or premature rupture
of membranes. They are bracketed together under the term “spontaneous preterm birth”
as opposed to iatrogenic preterm birth, for example as a consequence of preeclampsia
or fetal growth retardation. Recent studies suggest that low-dose aspirin does not
just reduce the rate of iatrogenic preterm births but can also further reduce the
rate of spontaneous preterm births. This review article presents the current state
of knowledge.
Method A selective literature search up until April 2020 was done in PubMed, using the terms
“randomized trial”, “randomized study”, “spontaneous preterm birth”, and “aspirin”.
Results Secondary analyses of prospective randomized studies on the prevention of preeclampsia
with low-dose aspirin show that this intervention also significantly reduced the rate
of spontaneous preterm births in both high-risk and low-risk patient populations.
The results of the ASPIRIN trial, a prospective, randomized, double-blinded multicenter
study carried out in six developing countries, also point in this direction, with
the figures showing that the daily administration of 81 mg aspirin starting before
14 weeks of gestation lowered the preterm birth rate of nulliparous women without
prior medical conditions by around 11% (11.6 vs. 13.1%; RR 0.89; 95% CI: 0.81 – 0.98,
p = 0.012).
Conclusion Further studies on this issue are urgently needed. If these confirm the currently
available results, then it would be worth discussing whether general aspirin prophylaxis
for all pregnant women starting at the latest in 12 weeks of gestation is indicated.
Key words
spontaneous preterm birth - iatrogenic preterm birth - prevention - preeclampsia -
aspirin
