Aspirin Dose Escalation for the Prevention of Recurrent Preterm Delivery Trial
- Conditions
- Preterm DeliveryObstetrical Complications
- Interventions
- Drug: 162mg Aspirin
- Registration Number
- NCT06980025
- Lead Sponsor
- The George Washington University Biostatistics Center
- Brief Summary
This is a phase-III multi-center double-blind randomized clinical trial of 1,800 individuals with a history of prior preterm birth at less than 35 weeks gestation who are randomized to either 162 mg aspirin or 81 mg aspirin daily. The study drug will be initiated between 10 and 15 weeks gestation and continued through 36 weeks, 6 days gestation. The primary endpoint is recurrent preterm delivery or fetal death prior to 35 weeks, 0 days gestation.
- Detailed Description
This is a phase-III multi-center double-blind randomized clinical trial of 1,800 individuals with a history of prior preterm birth at less than 35 weeks gestation who are randomized to either 162 mg aspirin or 81 mg aspirin daily.
The primary objective is to assess the efficacy of daily 162 mg of aspirin compared to 81 mg aspirin in reducing recurrent preterm delivery or fetal death before 35 weeks, 0 days gestation in individuals with a proximal birth between 20 weeks, 0 days and 34 weeks, 6 days gestation with spontaneous preterm delivery (sPTB), ischemic placental disease (IPD), or stillbirth. Ischemic placental disease includes small for gestational age, preeclampsia, or placental abruption.
The secondary objective is to assess the efficacy of daily 162 mg of aspirin compared to 81 mg aspirin in reducing ischemic placental disease in individuals with a proximal birth between 20 weeks, 0 days and 34 weeks, 6 days gestation with sPTB, IPD, or stillbirth.
Tertiary /Exploratory objectives are 1) to assess the efficacy of daily 162 mg of aspirin compared to 81 mg aspirin in reducing adverse maternal and neonatal outcomes, and 2) to assess maternal and neonatal safety in individuals with a proximal birth between 20 weeks, 0 days and 34 weeks, 6 days gestation with sPTB, IPD, or stillbirth.
Individuals will be randomized between 10 and 15 weeks gestation to either 162mg or 81mg of aspirin daily and continue the study intervention through 36 weeks, 6 days gestation. Participants will have monthly virtual or in-person visits through 37 weeks gestation to assess study intervention compliance, side effects, medication use, and unscheduled hospitalization. Maternal blood will be collected in a subset of the population. Research staff will abstract maternal and neonatal outcomes following delivery and discharge from the hospital.
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- Female
- Target Recruitment
- 1800
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14 years or older
-
Singleton gestation. Twin gestation reduced to a singleton, either spontaneously or therapeutically, is not eligible unless the reduction occurred before 13 weeks 6 days project gestational age. Higher-order multifetal gestations reduced to singletons are not eligible.
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Gestational age at randomization between 10 weeks 0 days and 15 weeks 6 days based on clinical information and evaluation of the earliest ultrasound.
-
Prior preterm birth between 20 weeks 0 days and 34 weeks 6 days with one of the following in the proximal birth reaching 20 weeks or greater:
- Spontaneous preterm birth is defined as spontaneous preterm labor or premature rupture of membranes
- Ischemic placental disease is defined as preeclampsia, small for gestational age, fetal growth restriction, or placental abruption, as defined clinically.
- Stillbirth excluding those with known genetic disorders or major congenital anomalies.
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Known allergy or hypersensitivity to aspirin or any medical condition where aspirin is contraindicated (e.g., history of peptic ulcer disease, nasal polyps, NSAID-induced asthma, history of gastrointestinal bleeding, known G6PD deficiency, severe hepatic dysfunction, bleeding disorders, and consumption of 3 or more alcoholic drinks per day)
-
Taking other anticoagulants such as Heparin or Low-Molecular weight Heparin
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Thrombocytopenia defined as a platelet count defined as a platelet count <100,000 microliters
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Gastric bypass surgery, regardless of type
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Aspirin use >81 mg daily during the current pregnancy who are not willing or able to go through a 2-week washout before randomization.
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Known major Mullerian anomaly of the uterus (specifically bicornuate, unicornuate, or uterine septum not resected) due to increased risk of preterm delivery.
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Known fetal genetic disease or major malformations
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Fetal demise or planned termination of pregnancy. Selective reduction by 13 weeks 6 days gestation, from twins to singleton, is not an exclusion.
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Any fetal/maternal condition requiring invasive in-utero assessment or treatment, for example, significant red cell antigen sensitization or neonatal alloimmune thrombocytopenia.
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Patients with any of the following medical conditions because of increased risk for adverse pregnancy outcome or indicated preterm birth:
- Treated hypertension requiring more than one agent
- Chronic renal disease with baseline serum creatinine ≥1.5 mg/dL
- Conditions treated with chronic oral glucocorticoid therapy (e.g., systemic lupus erythematosus)
- Uncontrolled hyper- and hypothyroid disease
- New York Heart Association (NYHA) stage II or greater cardiac disease
-
Planned indicated delivery prior to 37 weeks.
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Participation in another interventional study that influences the primary outcome in this study (gestational age at delivery).
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Participation in this trial in a previous pregnancy.
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Delivery planned at a non-participating site
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description 162mg Aspirin Daily 162mg Aspirin One 81mg capsule of aspirin daily through 36 weeks 6 days gestation. 81mg Aspirin Daily 81mg Aspirin Two 81mg capsules of aspirin daily through 36 weeks 6 days gestation.
- Primary Outcome Measures
Name Time Method Rate of recurrent preterm delivery or fetal death prior to 35 weeks 0 days gestation Between randomization and 35 weeks, 0 days gestation (a period of up to 25 weeks) Number and rate of participants who experience a recurrent preterm delivery or fetal death before 35 weeks, 0 days gestation.
- Secondary Outcome Measures
Name Time Method Rate of ischemic placental disease Between randomization and delivery (a period of up to 32 weeks) Number and rate of participants who experience ischemic placental disease (preeclampsia, small for gestational age \<10th percentile, or placental abruption). Small for gestational age is defined by "A 2017 US reference for singleton birth weight percentiles using obstetric estimates of gestation" by Aris et. al (2019).
Related Research Topics
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Trial Locations
- Locations (14)
University of Alabama - Birmingham
🇺🇸Birmingham, Alabama, United States
Regents of the University of California San Francisco
🇺🇸San Francisco, California, United States
Northwestern University
🇺🇸Chicago, Illinois, United States
Columbia University
🇺🇸New York, New York, United States
University of North Carolina - Chapel Hill
🇺🇸Chapel Hill, North Carolina, United States
Duke University
🇺🇸Durham, North Carolina, United States
Case Western Reserve University
🇺🇸Cleveland, Ohio, United States
Ohio State University
🇺🇸Columbus, Ohio, United States
Hospital of the University of Pennsylvania
🇺🇸Philadelphia, Pennsylvania, United States
Magee Women's Hospital of UPMC
🇺🇸Pittsburgh, Pennsylvania, United States
Brown Univeristy
🇺🇸Providence, Rhode Island, United States
Baylor College of Medicine
🇺🇸Houston, Texas, United States
University of Texas - Houston
🇺🇸Houston, Texas, United States
University of Utah Medical Center
🇺🇸Salt Lake City, Utah, United States