Use of non-aspirin NSAIDs during pregnancy may increase the risk of spontaneous abortion

Abstract

Data from this study support the assertion that the use ■ of non-steroidal anti-infl ammatory drugs (NSAIDs) during pregnancy is associated with increased risk of spontaneous abortion and should, therefore, be used with caution. However, other factors such as socio-economic status ■ and co-existing illnesses may have biased these results. Further research is needed to explore the effect of tak-■ ing NSAIDs during pregnancy and the other factors identifi ed. Future research should include data relating to the use ■ of both prescription and over-the-counter NSAIDs. ContextNSAIDs are one of the commonest classes of drugs taken by pregnant women. Data about the risks associated with this remains equivocal. The study by Nakhai-Pour et al explored whether the use of NSAIDs during pregnancy is associated with increased risk of spontaneous abortion. MethodsThis study examined data from one Province in Canada extracted from a provincial database. Women who had had a spontaneous abortion (n=4705) were matched with 47 050 controls. The use of NSAIDs was measured by whether or not the women fi lled a prescription for them during their pregnancy. Statistical analysis was carried out to explore whether there was any association between the use of nonaspirin NSAIDs and the risk of spontaneous abortion. FindingsThe use of NSAIDs during pregnancy appeared to be associated with increased risk of spontaneous abortion among the women included in the study. Other fi ndings indicated that spontaneous abortions were more common among (slightly) older women living in an urban received social assistance who had other co-existing healthcare conditions. Women who had a spontaneous abortion had had fewer prenatal visits and were taking more prescription medications than women who did not. CommentaryThis study has several limitations. First, the participants were more economically disadvantaged, had more medical problems and more likely to smoke compared with other Canadian women. 1 The authors state that these women account for 43% of the overall population, and 36% of pregnant women in the province. These numbers greatly contradict similar fi gures from a recent study by the same group. 1 Moreover, Nakhai-Pour and colleagues' initial paper concluded that the 'substantial differences between pregnant women insured by the RAMQ-Rx and those insured by private drug insurance plans' would 'most likely limit generalisability' of studies using the RAMQ database. 1 Second, the frequently used term 'index date' is diffi cult to interpret; is it the point at which the patient began spotting (or cramping) or when she had passed the aborted tissue? Clearly, this defi nition is critical, as NSAIDs may be prescribed for pain after the start of the spontaneous abortion − mitigating the claim that NSAID is the cause. Third, fi lling a prescription does not adequately represent actual use of the drug. The authors were unable to assess over-the-counter (OTC) NSAID usage. OTC medication use is extremely common during pregnancy (eg, ibuprofen). Until a stu...

Ibuprofen and Its Different Analytical and Manufacturing Methods: A Review

“…• A study of pregnant women suggests that those taking any type or amount of NSAIDs (including ibuprofen, diclofenac, and naproxen) were 2.4 times more likely to miscarry than those not taking the drugs [10].…”