Study suggests NSAIDs raise risk of miscarriage

A new Canadian study will change my care of and advice to women who are pregnant: Do NOT take NSAIDs (ibuprofen, naproxen, and others) while you are trying to get pregnant or if you are pregnant. Why? Read on …The study reports that “gestational exposure to any type or dosage of nonaspirin NSAIDs may increase the risk of spontaneous abortion. These drugs should be used with caution during pregnancy.”

ABC World News reported “some over the counter painkillers are a risk to pregnant women and their unborn children, doubling the risk of miscarriage.”

ABC explained, “This is a study out of Canada that looked at 4,700 women that had a miscarriage, and they compared those to 47,000 who did not. What they found was that the women who had miscarriages, in the first 20 weeks, were more than twice as likely to take a certain type of painkiller. This is a painkiller called NSAID. It’s in Aleve, Motrin, Ibuprofen.”

ABC added that pregnant women should “think about taking Tylenol, acetaminophen” for pain in pregnancy and I agree.

NBC Nightly News reported, “While the experts keep trying to learn more about what causes miscarriages, and how to prevent them, a new study of 47,000 women has found one more piece of the puzzle that women may want to consider, and it involves some big brand name pain relievers that are in so many of our homes in this country.”

NBC added, “Some of the most popular over-the-counter pain relievers, so-called NSAIDs, could be cause for concern early in pregnancy including ibuprofen … and naproxyn.”

These drugs “already carry warnings against use late in pregnancy, but the study out today from the team of University of Montreal, shows that taken early in pregnancy during the first 20 weeks, the drugs may more than double the risk of miscarriage.”

The Los Angeles Times reports in its “Booster Shots” blog, “The greatest risk was among women who had taken diclofenac, and the lowest among women who had taken rofecoxib alone.”

It also notes that “some previous studies on the connection between non-steroidal anti-inflammatory drugs and miscarriage or birth defects have shown a link,” including “a 2003 study in the British Medical Journal that linked NSAIDs “with an 80% greater risk of miscarriage,” though “a subsequent BMJ study found the data flawed.”

A 2011 study in PLoS One found that although no overall link was found between NSAID use during pregnancy and birth defects, there was a greater risk for septal (heart) defects and exposure to multiple non-steroidal anti-inflammatory drugs in a very small number of cases.

So, although the data are somewhat conflicting and even a bit confusing, I’m recommending pregnant women NOT take NSAIDs at all. Why? Simple.

Since there is a potential risk with taking any NSAID in pregnancy, and since there is a safe and effective alternative, until further notice, all pregnant women should use acetaminophen (Tylenol and others) for pain or fever during pregnancy.

The current study is published in the Canadian Medical Association Journal.

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