Recently, in the American Journal of Obstetrics & Gynecology, there was an article published that assessed the effects of drugs like ibuprofen, naproxen, diclofenac, and celecoxib in early pregnancy. They found that there is an increased risk of miscarriage with the use of these drugs, and higher dosages increased risk. If you are trying to get pregnant, and need more consevative ways to help you with any pain that you’re dealing with, please consider calling on us to see if we can help. ~ Dr. Broussard
Reuters Health News | June 21, 2018
Using non-steroidal anti-inflammatory drugs (NSAIDs) around the time of conception significantly increases the risk of miscarriage in the first 8 weeks of pregnancy, a study suggests.
Researchers compared newly pregnant women who used NSAIDs around the time of conception or early in their pregnancy to those who used acetaminophen or no painkillers, and found using NSAIDs around conception carried a more than four-fold higher risk of early miscarriage.
The results support earlier evidence that NSAIDs interfere with prostaglandins critical for implantation of an early embryo in the uterus, the study team writes online June 8 in the American Journal of Obstetrics & Gynecology.
“The category of NSAID medications was invented to relieve pain and reduce inflammation. The way this category of medications accomplishes these pharmacologic effects is by inhibiting the production of prostaglandin,” said lead study author Dr. De-Kun Li, a researcher with the Kaiser Foundation Research Institute of Kaiser Permanente Northern California in Oakland.
“It turns out that a sufficient amount of prostaglandin needs to be present for successful embryonic implantation. Thus, a reduced amount of prostaglandin due to NSAID use around the time of conception could lead to difficulties of implantation of the embryo, and miscarriage,” Li said in an email.
The connection between NSAIDs’ pharmacologic effect of inhibiting prostaglandin production to increased risk of miscarriage is not well known yet, Li noted.
NSAIDs, such as ibuprofen, naproxen, diclofenac, and celecoxib, are available by prescription and OTC and are commonly used to relieve fever and pain. They are also among the most commonly used drugs by pregnant women, the study team notes.
To assess the effects of NSAID use early in pregnancy, Li and colleagues recruited 241 women who took only NSAIDs around the time of conception and during the first 20 weeks of pregnancy, 391 who took only acetaminophen during this period and 465 women who took neither type of medication. The women were, on average, 39 days pregnant.
About 24% of the women who took NSAIDs had miscarriages within the first 20 weeks of pregnancy, compared with 16% of women who took acetaminophen and 17% of women who took neither medication.
After accounting for other factors that can influence miscarriage risk, including age, caffeine intake, smoking during pregnancy, multivitamin use, fevers, and other health issues, the researchers found that overall, women who took NSAIDS had a 59% higher risk of miscarriage than women who took no painkillers.
NSAID users also had a 45% higher miscarriage risk than acetaminophen users.
When researchers looked at timing, the added risk was almost entirely among women who used NSAIDs around the time of conception, and these miscarriages were most likely to be within the first 8 weeks of pregnancy.
The degree of risk also increased for women who used NSAIDs for 2 weeks or more compared with those who took them for less time.
“If pregnant women are concerned about NSAID use around conception, they should talk with their clinicians about their concern,” said Dr. Tracy Flanagan, director of Women’s Health at Kaiser Permanente Northern California in Richmond, who wasn’t involved in the study.
She pointed out that although there is a plausible mechanism for how NSAID use would lead to a higher risk of miscarriage, a study like this can only show an association, it doesn’t prove causation.
“Overall, this study is a step forward for this research area, but a systematic review of this and the previous studies that have been done on this topic might help to clarify the role of painkillers on miscarriage,” said Anne Marie Jukic, a researcher at the School of Public Health at Yale Universtiy in New Haven, Connecticut, who wasn’t involved in the study.
The FDA recommends that women consult with their health-care providers before taking pain medicines during pregnancy, whether OTC or prescription, Jukic said in an email.
—Shereen Lehman
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