A large study led by Scottish researchers from the University of Aberdeen cautions that expectant mothers using the medications have about one and half times greater risks of a preterm delivery, stillbirth or neonatal death, physical defects and other problems, compared with those who did not take these drugs.
Because of the findings suggesting increased odds of adverse neonatal outcomes associated with common analgesics such as aspirin and ibuprofen, healthcare guidance for pregnant women "should be reassessed,” according to first investigator Aikaterini Zafeiri from the University of Aberdeen.
Dr. Zafeiri was to present the findings as poster 732 at the 37th virtual Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE).
An ESHRE press release points out that between 30% and 80% of pregnant women internationally use nonprescription painkillers in pregnancy to relieve symptoms including pain, influenza, fever, inflammatory, or rheumatological conditions.
For the analysis, data was collected from the Aberdeen Maternity and Neonatal Databank from 1985 to 2015. Researchers focused on 151,141 singleton pregnancies, reviewing medical notes for use of five painkillers—paracetamol (acetaminophen), aspirin, and the nonsteroidal anti-inflammatory drugs (NSAIDs) diclofenac, naproxen, and ibuprofen—either as single compounds or in combinations.
Results indicate that 29% of the women took OTC analgesics during pregnancy, although the percentage more than doubled to 60% during the last 7 years of the 30-year study period. Based on that information, researchers suggest that use of OTC painkillers is burgeoning for expectant mothers, adding that 84% of the women reported ingesting painkillers during the first 12 weeks after conception.
The study uncovered associations between increased health risks for pregnancies and exposure to at least one of the five analgesics. Based on significance determined by adjusted odds ratio (AOR) were:
• Neural tube defects (1.64% AOR)
• Admission to a neonatal unit (1.57% AOR)
• Neonatal death (1.56% AOR)
• Premature delivery before 37 weeks (1.50% AOR)
• Baby’s condition at birth based on APGAR score of less than 7 at 5 minutes (1.48% AOR)
• Stillbirth (1.33% AOR)
• Birthweight under 2.5kg (1.28% AOR)
• Hypospadias, a birth defect affecting the penis (1.27% AOR)
• Baby’s condition at birth based on APGAR score of less than 7 at 1 minute (1.18% AOR)
• Birth weight over 4 kg (1.09% AOR)
Only using paracetamol/acetaminophen, which is widely considered safe, was linked somewhat with high birth weight, neural-tube defects, and hypospadias, according to the authors. On the other hand, diclofenac use was associated with significantly decreased odds of stillbirth, a protective effect which the authors say may be attributed to its stronger anti-inflammatory effects than the other NSAIDs studied.
Dr. Zafeiri raises concerns about the combination of ease of access to non-prescription painkillers combined with misinformation on the Internet. “This is especially when mis-informed or partially-informed self-medication decisions are taken during pregnancy,” she notes.
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