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Abstract：
BACKGROUND: Preterm birth is a leading cause of perinatal morbidity and mortality. There are significant racial disparities in the rates of preterm delivery in the United States, with Black individuals at disproportionately higher risk than their White counterparts. Although low-dose aspirin is currently under investigation for reducing the rates of preterm delivery, limited data are available on how the use of low-dose aspirin might affect racial and ethnic disparities in the rates of preterm delivery.
OBJECTIVE: Our group and others have shown that low-dose aspirin decreases spontaneous preterm delivery in low-risk parturients. This study aimed to examine whether the relationship between low-dose aspirin and the risk of spontaneous preterm delivery is modified by race and ethnicity.
METHODS: This was a secondary analysis of a randomized clinical trial examining low-dose aspirin for preeclampsia prevention in low-risk nulliparous individuals. The parent trial defined low risk as the absence of preexisting hypertension or other medical comorbidities. Participants received 60-mg aspirin or placebo between 13 and 25 weeks of gestation. Here, multiple pregnancies, fetal anomalies, terminations or abortions at <20 weeks of gestation, and participants with previous miscarriages were excluded. Our exposure, race and ethnicity, was self-reported in the parent trial and categorized as non-Hispanic White, Hispanic, non-Hispanic Black, and other. The primary outcome was spontaneous preterm delivery at <34 weeks of gestation; the secondary outcomes included spontaneous preterm delivery at <37 weeks of gestation and all preterm deliveries at <34 and <37 weeks of gestation. Fit logistic regression models were used to examine how the use of low-dose aspirin modified the relationship between race and ethnicity and preterm delivery, adjusting for confounders. Furthermore, sensitivity analyses were performed to compare the rates of preterm delivery by race and ethnicity.
RESULTS: Of note, 2528 of 3171 parent study participants were included in this analysis. Of the participants, 425 (16.8%) were White, 819 (32.4%) were Hispanic, 1265 (50%) were Black, and 19 (0.8%) were other. The baseline characteristics differed among racial and ethnic groups, including maternal age, body mass index, education level, marital status, tobacco and alcohol use, and pregnancy loss. The rate of spontaneous preterm delivery at <34 weeks of gestation was significantly higher in Black participants (2.8%) than in White (1.2%) and Hispanic (1.2%) participants (P=.04). Logistical regression analysis showed that Black race was no longer an independent risk factor for spontaneous preterm delivery at <34 weeks of gestation when controlling for low-dose aspirin (adjusted odds ratio, 1.71; 95% confidence interval, 0.67-4.40). A similar pattern was found for spontaneous preterm delivery at <37 weeks of gestation and preterm delivery at <34 and <37 weeks of gestation. In our sensitivity analyses, spontaneous preterm delivery at <34 weeks of gestation differed by race and ethnicity in the placebo group (P=.01) but did not differ in the low-dose aspirin group (P=.90).
CONCLUSIONS: The use of low-dose aspirin mitigated racial disparities in spontaneous preterm delivery at <34 weeks of gestation. Additional investigation is warranted to assess the reproducibility of our findings.
OBJECTIVE: Our group and others have shown that low-dose aspirin decreases spontaneous preterm delivery in low-risk parturients. This study aimed to examine whether the relationship between low-dose aspirin and the risk of spontaneous preterm delivery is modified by race and ethnicity.
METHODS: This was a secondary analysis of a randomized clinical trial examining low-dose aspirin for preeclampsia prevention in low-risk nulliparous individuals. The parent trial defined low risk as the absence of preexisting hypertension or other medical comorbidities. Participants received 60-mg aspirin or placebo between 13 and 25 weeks of gestation. Here, multiple pregnancies, fetal anomalies, terminations or abortions at <20 weeks of gestation, and participants with previous miscarriages were excluded. Our exposure, race and ethnicity, was self-reported in the parent trial and categorized as non-Hispanic White, Hispanic, non-Hispanic Black, and other. The primary outcome was spontaneous preterm delivery at <34 weeks of gestation; the secondary outcomes included spontaneous preterm delivery at <37 weeks of gestation and all preterm deliveries at <34 and <37 weeks of gestation. Fit logistic regression models were used to examine how the use of low-dose aspirin modified the relationship between race and ethnicity and preterm delivery, adjusting for confounders. Furthermore, sensitivity analyses were performed to compare the rates of preterm delivery by race and ethnicity.
RESULTS: Of note, 2528 of 3171 parent study participants were included in this analysis. Of the participants, 425 (16.8%) were White, 819 (32.4%) were Hispanic, 1265 (50%) were Black, and 19 (0.8%) were other. The baseline characteristics differed among racial and ethnic groups, including maternal age, body mass index, education level, marital status, tobacco and alcohol use, and pregnancy loss. The rate of spontaneous preterm delivery at <34 weeks of gestation was significantly higher in Black participants (2.8%) than in White (1.2%) and Hispanic (1.2%) participants (P=.04). Logistical regression analysis showed that Black race was no longer an independent risk factor for spontaneous preterm delivery at <34 weeks of gestation when controlling for low-dose aspirin (adjusted odds ratio, 1.71; 95% confidence interval, 0.67-4.40). A similar pattern was found for spontaneous preterm delivery at <37 weeks of gestation and preterm delivery at <34 and <37 weeks of gestation. In our sensitivity analyses, spontaneous preterm delivery at <34 weeks of gestation differed by race and ethnicity in the placebo group (P=.01) but did not differ in the low-dose aspirin group (P=.90).
CONCLUSIONS: The use of low-dose aspirin mitigated racial disparities in spontaneous preterm delivery at <34 weeks of gestation. Additional investigation is warranted to assess the reproducibility of our findings.
摘要：
背景：早产是围产期发病率和死亡率的主要原因。美国早产率存在显著的种族差异，黑人的风险比白人高得多。尽管目前正在研究低剂量阿司匹林以降低早产率，关于低剂量阿司匹林的使用如何影响早产率的种族和族裔差异的数据有限.
目的：我们的研究小组和其他研究表明，低剂量阿司匹林可降低低危产妇的自发性早产。这项研究旨在研究低剂量阿司匹林与自发性早产风险之间的关系是否因种族和种族而改变。
方法：这是一项随机临床试验的二级分析，该试验检查了低剂量阿司匹林在低风险未产个体中预防先兆子痫的作用。母体试验将低风险定义为没有预先存在的高血压或其他医学合并症。参与者在妊娠13至25周之间接受60毫克阿司匹林或安慰剂。这里,多胎妊娠,胎儿畸形,妊娠<20周时终止妊娠或流产，既往流产的参与者被排除在外.我们的曝光，种族和民族,在父母试验中自我报告，并归类为非西班牙裔白人，西班牙裔,非西班牙裔黑人,和其他。主要结局是妊娠<34周时的自发性早产；次要结局包括妊娠<37周时的自发性早产和妊娠<34周和<37周时的所有早产。Fitlogistic回归模型用于检查低剂量阿司匹林的使用如何改变种族和民族与早产之间的关系。适应混杂因素。此外，我们进行了敏感性分析,以按种族和民族比较早产率.
结果：值得注意的是，3171名父母研究参与者中的2528人被纳入本分析。在参与者中，425名（16.8%）为白人，819人（32.4%）是西班牙裔，1265（50%）是黑人，19人(0.8%)为其他。种族和族裔群体的基线特征不同，包括产妇年龄,身体质量指数,教育水平,婚姻状况,烟草和酒精的使用，怀孕的损失。妊娠<34周时自发早产率黑人参与者（2.8%）明显高于白人（1.2%）和西班牙裔（1.2%）参与者（P=.04）。Logistic回归分析显示，在控制低剂量阿司匹林时，在<34孕周，黑人种族不再是自发早产的独立危险因素（调整后的比值比，1.71；95%置信区间，0.67-4.40）。对于妊娠<37周的自发早产和妊娠<34和<37周的早产也发现了类似的模式。在我们的敏感性分析中，妊娠<34周时自发性早产在安慰剂组的种族和民族方面存在差异(P=.01),但在低剂量阿司匹林组没有差异(P=.90).
结论：在妊娠34周时，低剂量阿司匹林的使用减轻了自发性早产的种族差异。需要进行额外的调查以评估我们发现的可重复性。
目的：我们的研究小组和其他研究表明，低剂量阿司匹林可降低低危产妇的自发性早产。这项研究旨在研究低剂量阿司匹林与自发性早产风险之间的关系是否因种族和种族而改变。
方法：这是一项随机临床试验的二级分析，该试验检查了低剂量阿司匹林在低风险未产个体中预防先兆子痫的作用。母体试验将低风险定义为没有预先存在的高血压或其他医学合并症。参与者在妊娠13至25周之间接受60毫克阿司匹林或安慰剂。这里,多胎妊娠,胎儿畸形,妊娠<20周时终止妊娠或流产，既往流产的参与者被排除在外.我们的曝光，种族和民族,在父母试验中自我报告，并归类为非西班牙裔白人，西班牙裔,非西班牙裔黑人,和其他。主要结局是妊娠<34周时的自发性早产；次要结局包括妊娠<37周时的自发性早产和妊娠<34周和<37周时的所有早产。Fitlogistic回归模型用于检查低剂量阿司匹林的使用如何改变种族和民族与早产之间的关系。适应混杂因素。此外，我们进行了敏感性分析,以按种族和民族比较早产率.
结果：值得注意的是，3171名父母研究参与者中的2528人被纳入本分析。在参与者中，425名（16.8%）为白人，819人（32.4%）是西班牙裔，1265（50%）是黑人，19人(0.8%)为其他。种族和族裔群体的基线特征不同，包括产妇年龄,身体质量指数,教育水平,婚姻状况,烟草和酒精的使用，怀孕的损失。妊娠<34周时自发早产率黑人参与者（2.8%）明显高于白人（1.2%）和西班牙裔（1.2%）参与者（P=.04）。Logistic回归分析显示，在控制低剂量阿司匹林时，在<34孕周，黑人种族不再是自发早产的独立危险因素（调整后的比值比，1.71；95%置信区间，0.67-4.40）。对于妊娠<37周的自发早产和妊娠<34和<37周的早产也发现了类似的模式。在我们的敏感性分析中，妊娠<34周时自发性早产在安慰剂组的种族和民族方面存在差异(P=.01),但在低剂量阿司匹林组没有差异(P=.90).
结论：在妊娠34周时，低剂量阿司匹林的使用减轻了自发性早产的种族差异。需要进行额外的调查以评估我们发现的可重复性。
