What is a cheap and safe way to increase the chances of having a baby after a miscarriage?

Women who adhered to low-dose aspirin regimens after a miscarriage were more likely to achieve subsequent births, a secondary analysis of randomized controlled trial data showed.

Dr. Ashley Naimi of the Eunice Kennedy Schreiber National Institute of Pediatric Health reported that taking low doses of aspirin at least 5 days a week increased births by 15 per 100 women compared to the placebo group (95). % CI 7.65-21.15). Human development in Rockville, Maryland and its colleagues.

People in the aspirin group also had 8 human chorionic gonadotropin (hCG) detected pregnancies (95% CI 4.64-10.96) and 6 loss of pregnancy (95% CI -12.00 to -0.20) per 100 women. ) Had. Annual report of internal medicine..

The effect of aspirin was stronger the earlier it was administered, with the greatest effect being seen in women who took it before pregnancy. Researchers say the effects of low-dose aspirin regimens are diminished when started 6 weeks after pregnancy.

“We found that using aspirin at least four times a week before pregnancy up to 36 weeks of gestation increased pregnancy detected by hCG, reduced pregnancy loss, and thereby increased births by more than 30%. “Naimi et al. Wrote. “This evidence confirms the need to focus on improving daily compliance. [low-dose aspirin] To maximize effectiveness for pregnancy outcomes. “

Naimi et al. Performed a protocol-by-protocol analysis of the data from. EAGeR (Effect of Aspirin on Pregnancy and Reproduction) Study, A multicenter, randomized, double-blind, placebo-controlled trial by four university medical centers in the United States

Previous findings from EAGeR show that aspirin May increase the chances of a woman becoming pregnant after a recent miscarriage It happened 20 weeks before pregnancy. However, the effect was not passed on to a wider group of women. Therefore, the trial failed.

In a post-study analysis, Naimi’s group examined 1,227 women aged 18-40 years with no history of infertility. These women had previously lost one or two pregnancies and were about to become pregnant.

The women in this analysis showed higher dosing adherence, reflecting the best potential effects of aspirin when patients adhered to the usual low-dose regimen. These findings complement previous findings by adjusting for non-compliance with the research protocol.

Participants were randomized to receive either 81 mg of aspirin or placebo. They were instructed to take the assigned medication and 400 mcg of folic acid through 6 daily menstrual cycles, up to 36 weeks gestation if pregnant. Researchers evaluated medication compliance by weighing bottles on a regular basis during follow-up.

Of the 615 women in the aspirin cohort and the 612 women in the placebo group, there was no difference in overall medication adherence (68% vs. 66%). However, among pregnant study participants, adherence decreased from 74% before conception to 64% after conception. More than half of the women adhered to the study protocol for more than 70% of the study period.

Those who took aspirin throughout the follow-up period had more pregnancies detected by hCG (risk ratio) [RR] Compare 1.12, 95% CI 1.02-1.23) and birth (RR 1.33, 95% CI 1.08-1.64) with the placebo group. In addition, participants who adhered to the low-dose aspirin regimen had a approximately 30% reduction in risk of miscarriage (RR 0.69, 95% CI 0.50-0.95).

Taking aspirin was effective both before and after pregnancy, but especially for the consequences of miscarriage, it was more effective for women to take it earlier. Miscarriage RRs ranged from 0.70 (95% CI 0.47-1.04) when treatment was started 6 weeks gestation to 0.93 (95% CI 0.65-1.33) when treatment was started 20 weeks gestation.

Naimi et al. Recognize that the EAGER trial consists mostly of women in well-educated high-income households, which may limit the generalization of findings. In addition, there were too few cases of adverse events such as preterm birth and pre-eclampsia, and the authors of the study could not assess the effect of aspirin on these results.

They concluded that based on changes in adherence before and after conception, clinicians should know when patients are most likely to stick to their dosing regimen. Future studies should focus on efforts to improve compliance, including alternative drug delivery channels and donor and patient education, they added.