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Is NSAID Use Safe During Pregnancy?

Am J Obstet Gynecol; ePub 2018 Jun 8; Li, et al

The use of non-steroidal anti-inflammatory drugs (NSAIDs) around the time of contraception is associated with increased risk of miscarriage with a dose-response relationship, a new study found. Researchers examined the impact of NSAID use in early pregnancy on the risk of miscarriage, especially during the timing and duration of use. 1,097 pregnant women were recruited very early in pregnancy to achieve optimal ascertainment of miscarriage. Based on use of NSAIDs and acetaminophen, 3 cohorts were formed: 1) women who used NSAIDs only; 2) women who used acetaminophen only (to control for indication); and 3) women who used neither NSAIDs nor acetaminophen (unexposed controls). Among the findings:

  • NSAID use during pregnancy was associated with a statistically significant increased risk of miscarriage compared to both unexposed controls (adjusted HR=1.59) and acetaminophen users (aHR=1.89), after adjusting for multiple confounders.
  • The risk was mainly due to NSAID use around contraception with a statistically significant dose-response relationship (aHR=1.37) for NSAID use of ≤14 days and aHR=1.85 for NSAID use of ≥15 days.
  • The association was stronger for early miscarriage.
  • Women with lower body mass index (BMI) may be more susceptible to the effect of NSAID use around conception.

Citation:

Li DK, Ferber JR, Odouli R, Quesenberry C. Use of non-steroidal anti-inflammatory drugs during pregnancy and the risk of miscarriage. [Published online ahead of print June 8, 2018]. Am J Obstet Gynecol. doi:10.1016/j.ajog.2018.06.002.