Beware of NSAIDs in Early Pregnancy

A new study found that these agents increase risk of miscarriage



A study in the American Journal of Obstetrics & Gynecology analyzed pregnant women from the Kaiser Permanente healthcare system and compared newly pregnant women who took non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen or neither and found that using NSAIDs around conception carried a more than fourfold higher risk of early miscarriage.

While it is known that NSAIDs should be avoided after week 32 (to prevent premature closure of the ductus arteriosus), there are mixed messages regarding the use of NSAIDs during conception or early pregnancy.

The researchers enrolled 1,097 pregnant women, all of whom were very early in pregnancy (median gestational age at enrollment was 39 days) to best ascertain fetal outcomes (including miscarriage). Among the eligible women contacted, 63% agreed to participate in the study.

NSAID use during pregnancy was associated with a significantly (59%) increased risk of miscarriage compared with unexposed controls (adjusted hazard ratio [HR] 1.59) or a 45% increased risk in those exposed to acetaminophens (adjusted HR 1.45). Nearly one-quarter of the women who took NSAIDs had miscarriages within the first 20 weeks of pregnancy, compared with 16% of those who took acetaminophen and 17% of women who took neither medication.

Most of the risk was evident for NSAID use around conception (adjusted HR 1.89), with a statistically significant dose-response relationship (adjusted HR 1.37) for NSAID use of 14 days or less (adjusted HR 1.85) for NSAID use of 15 days or more.

The association was stronger for early miscarriage at less than 8 weeks gestational age (adjusted HR 4.08, 95% CI 2.25-7.41). Women with a lower body-mass index (BMI) -- i.e., <25 -- appeared to be more susceptible to the effect of NSAID use around conception (adjusted HR 3.78) than women with high BMI (≥25) (adjusted HR 1.03).

NSAIDs are also among the most commonly used drugs by pregnant women, and the risk may be greater with longer NSAID use, since women who used NSAIDs for at least 2 weeks or more had more miscarriages than those who took them for less time.

NSAID use around conception was associated with an increased risk of miscarriage, with a dose-response relationship, especially in women with a lower BMI.


Source