Wednesday, 17 Oct 2018

You are here

NSAID Use Around Conception Increases Miscarriage Risk

A study from 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 showed that using NSAIDs around conception carried a more than four-fold higher risk of early miscarriage. (Citation source: http://bit.ly/2tqNWN6)

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.

They enrolled pregnant women (N=1,097) who were very early in pregnancy (median gestational age at enrollment was 39 days) to best ascertain fetal outcomes (including miscarriage.  Among 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 to either unexposed controls (adjusted hazard ratio (aHR)=1.59) or 45% increased risk if exposed to acetaminophen use (aHR=1.45). Nearly one-quarter of the women who took NSAIDs had miscarriages within the first 20 weeks of pregnancy, compared with 16 percent of women who took acetaminophen and 17 percent of women who took neither medication.

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

The association was stronger for early miscarriage (<8 weeks gestational age): aHR=4.08 (95% CI: 2.25 to 7.41). Women with lower BMI (<25) appeared to be more susceptible to the effect of NSAID use around conception (aHR=3.78) than women with high BMI (≥25) (aHR=1.03).

NSAIDs are also among the most commonly used drugs by pregnant women.  These risk may be greater with longer NSAID use as women who used NSAIDs for two weeks or more had more miscarriages than those who took them for less time.

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

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Update on Immune Checkpoint Inhibitor Toxicity

JAMA has a 2018 update/review of the safety issues seen with mmune checkpoint inhibitors (ICIs) - important new cancer therapies, with 14 cancer indications, that have significantly improved survival in several. ICIs are monoclonal antibodies that block inhibitors of T-cell activation and function.

New BSR Guidelines on Biologic Safe Use with Inflammatory Arthritis

The British Society of Rheumatology has produced a set of NICE accredited guidelines for the use of biologic therapies in patients with inflammatory arthritis.

It addresses safety recommendations for all biologic therapies approved by the National Institute for Health and Care Excellence (NICE) up to June 2016, for use in all inflammatory arthritides [RA, PsA and axial SpA (SpA) including AS].

The Safety of Paternal Exposure to DMARDs and Biologics

Pregnancy and drug safety is a complex issue, often with limited informatoin about maternal drug exposure on the offspring. Greater uncertainty exists when considering whether paternal exposure may also influence fetal outcomes.

A systematic review examined the effect of disease modifying anti-rheumatic drugs (DMARDs) on male fertility and if peri-conception (within 3 months) paternal exposure was detrimental to fetal outcomes.

2018-2019 ACIP Recommendations for Seasonal Influenza Vaccination

The current issue of the CDC's MMWR reviews the new seasonal recommendations for vaccination against influenza. This is an update to the previous recommendations of the Advisory Committee on Immunization Practices (ACIP). 

Health Secretary Azar Eyes Rebate Reform

Reuters reports that the U.S. Health and Human Services Secretary Alex Azar had declared his agency has the authority to eliminate rebates on prescription drug purchases, a key element in the administration’s plan to lower prescription medicine costs.

Azar has said rebates created a perverse incentive to continuously raise drug prices.