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February 19, 2014
NSAIDs During Pregnancy Don’t Increase Spontaneous Abortion Risk

Be’er-Sheva, Israel—Women who use nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain, fever, and inflammation during pregnancy are not increasing their risk for miscarriages, according to a new Israeli study.

The report, published recently in the Canadian Medical Association Journal, points out that drugs such as ibuprofen, naproxen, and diclofenac are increasingly used by pregnant women in the first trimester but that previous studies have been inconclusive on the risks of spontaneous abortion.

For the study, researchers looked at data on 65,457 women between the ages of 15 and 45 years who were admitted to Soroka Medical Center in Be’er-Sheva, Israel, between January 2003 and December 2009. Most, 90%, were there to give birth, but about 10% of the women were hospitalized after miscarriages.

Of the total group, 4,495, or 6.9%, took NSAIDs during the first trimester of pregnancy. Those women tended to be older, more likely to smoke, and more likely to suffer inflammatory diseases. In addition, more of the pregnant women using NSAIDs had undergone in-vitro fertilization (IVF) than in those who did not take NSAIDs.

Study results indicate that about 8.2% of women in the group exposed to NSAIDs had miscarriages compared with 10% of women in the group that did not take NSAIDs.

In a small group of women who took COX-2-selective inhibitors, 17% had a miscarriage, and study authors called for further research on that issue.

“We found no important associations between exposure to NSAIDs, either by group or for most specific NSAID drugs, and risk of spontaneous abortion,” the authors write. “However, we found an increased risk of spontaneous abortion following exposure to indomethacin.”

That may be due to “reverse causation bias” because indomethacin was dispensed at the end of pregnancy, likely to treat preterm labor, which is a different indication than other NSAIDs, they suggest.

“The fact that the study was based on large proportion of the district population, was adjusted to nearly all known risk factors for miscarriages (tobacco use, obesity, IVF, uterine malformations, hyper-coagulable conditions, intrauterine contraceptive device, etc.) and used advanced statistical methods strengthens the validity of the results,” states principal investigator Amalia Levy, PhD.




U.S. Pharmacist Social Connect