NSAIDs in Early Pregnancy May Double Miscarriage Risk

Pregnant women might want to think twice before they take an NSAID for that headache. According to a new study, use of nonaspirin NSAIDs in early pregnancy, such as ibuprofen and naproxen, can double the risk of miscarriage.

In addition to ibuprofen and naproxen, nonaspirin NSAIDs (non-steroidal anti-inflammatory drugs) include medications like the Cox-2 inhibitor Celebrex. They are generally used to treat inflammation, mild to moderate pain caused by headaches, arthritis, injuries and menstrual cramps, as well as fever. It is estimated that 30 million Americans take NSAIDS everyday, and according to a report from MSNBC, they are among the drugs most frequently taken by pregnant women.

This new study, which appears in the Canadian Medical Association Journal, involved an examination of health records from nearly 50,000 Canadian women. Women ranged in age from 15 to 45 years old on the first day of gestation. Exposure to nonaspirin NSAIDs was defined as having filled at least one prescription for any type of the drug during the first 20 weeks of pregnancy or in the two weeks prior to the start of the pregnancy. Naproxen was the most commonly used nonaspirin NSAID followed by ibuprofen.

The research team looked a total of 4,705 cases of miscarriage up to the 20th week of gestation, 352 (7.5%) of whom took nonaspirin NSAIDs. Of the 47,050 women in the control group who did not miscarry, 1213 (2.6%) had been exposed to nonaspirin NSAIDs.

“The use of nonaspirin NSAIDs during early pregnancy is associated with statistically significant risk (2.4-fold increase) of having a spontaneous abortion,” Dr. Anick Bérard, from the University of Montreal and the Director of the Research Unit on Medications and Pregnancy at CHU Ste-Justine, wrote. “We consistently saw that the risk of having a spontaneous abortion was associated with gestational use of diclofenac, naproxen, celecoxib, ibuprofen and rofecoxib alone or in combination, suggesting a class effect.”

Medication dosage did not appear to affect miscarriage risk, according to the study. The highest risk was seen among women who took diclofenac, while the lowest risk was seen in those who took rofecoxib. Rofecoxib, known more commonly as Vioxx, was withdrawn from the market in 2006 because of its association with heart attacks and strokes.

The study team hypothesized that because NSAIDs affect the levels of hormone-like substances known as prostaglandins, they could impact pregnancy. While prostaglandins decrease in the uterus in a consistent way during pregnancy, taking NSAIDs could cause a wider fluctuation, they surmised.

According to the study authors, women in the first trimester of pregnancy should be careful about using NSAIDs

“Given that the use of nonaspirin NSAIDs during early pregnancy has been shown to increase the risk of major congenital malformations and that our results suggest a class effect on the risk of clinically detected spontaneous abortion, nonaspirin NSAIDs should be used with caution during pregnancy.” they wrote.

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