28 Apr NSAIDS in Early Pregnancy and Miscarriage Risk?
Miscarriage is common for early pregnancy with around 15% of pregnancies ending in loss. Approximately 80% of miscarriages occur in the first trimester, before the 12th week of gestation. Many factors are known to increase the risk for miscarriage, including obesity, genetic abnormalities, smoking, maternal diseases, and consumption of alcohol. Several earlier studies suggest that using nonsteroidal anti-inflammatory drugs (NSAIDs) will increase the risk for miscarriage.
NSAIDs are anti-inflammatory agents that have antipyretic, analgesic, and platelet-inhibitory actions. These medicines are used mainly for the treatment of chronic arthritis and soft tissue disorders, which are associated with inflammation and pain. These medicines are non-addictive and considered safe when taken appropriately.
NSAIDs are used during pregnancy for fevers, mild illnesses, aches, pains, inflammatory bowel disease, and chronic rheumatic disease. NSAIDs have also been used for delaying early delivery for at least 48 hours and up to 10 days.
NSAIDs cross the placenta and can harm to the unborn child, which depends on the type of agent, the dose and duration of therapy, the gestational period, and the time elapsed between maternal NSAID administration and delivery.
According to a new study conducted by Levy and associates, nonsteroidal anti-inflammatory drugs will not increase a pregnant woman’s risk for miscarriage. However, prescription NSAID indomethacin is linked to a higher rate of pregnancy loss, as was the cox-2 inhibitor celecoxib (Celebrex). The researchers reviewed the records of 65,000 women conceived between January 2003 and December 2009. As many as 6,500 women miscarried during their pregnancy, and NSAIDs were used by 4,495 of these women.
Over-the-counter NSAIDS are not associated with miscarriage, including naproxen (Aleve) and ibuprofen (Motrin). These medications did not cause preterm labor. NSAIDs like these are frequently used by pregnant women, because they are indicated for common symptoms like fever and pain.
Overall, the risk of miscarriage for women taking prescription NSAIDs is around 8%, which includes indomethacin. When researchers looked at women taking only indomethacin, the risk for miscarriage was 2.8 times higher than with NSAIDs. For women on cox-2 inhibitors, that risk rose to 40%, according to the study.
One consideration for pregnant women is that they often forget that many of these over-the-counter drugs have multi-ingredients, and one of these ingredients may not be safe in pregnancy. In addition, the widespread availability of NSAIDs can lull pregnant women into a false sense of safety. One expert recommends stricter labeling for these drugs, as many can cause serious problems.
Another finding based on a case-control study, meconium (newborn feces) collected from 101 infants was found to have NSAIDs, including aspirin, ibuprofen, indomethacin, and naproxen. Overall, 50% of the samples were positive for NSAIDs, with 23% of them showing ibuprofen and 44% of them showing aspirin. This happens because NSAIDs block the synthesis of thromboxane and prostaglandins, which are required to keep open the ductus arterious (blood vessel that shunts blood past the lungs in the fetus). This study also showed an increased risk for miscarriage for women who take NSAIDs.
Antonucci R, Zaffanello M, Puxeddu E, et al. (2012). Use of non-steroidal anti-inflammatory drugs in pregnancy: impact on the fetus and newborn. Current Drug Metabolism, 13(4), 474-490.
Daniel S, Koren G, Lunenfeld E, Levy A. Fetal exposure to nonsteroidal anti-inflammatory drugs and spontaneous abortions. Canadian Medical Association Journal. 2014.