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Ibuprofen Linked to Increased Risk of Miscarriage
Taking ibuprofen or any class of nonsteroidal anti-inflammatory drugs (NSAIDs) while pregnant more than doubles the risk of miscarriage, according to a recent study published in the Canadian Medical Association Journal.
Naproxen, diclofenac, rofecoxib and celecoxib are also NSAIDS. Common brand names for NSAIDs are Advil, Motrin, Nuprin, Aleve, Naprosyn and Celebrex.
The University of Montreal researchers examined the risk of miscarriage associated with the types and dosages of nonaspirin NSAIDs. They looked at a total of 4,705 cases of miscarriage up to the 20th week of gestation. Of those 352 (7.5 percent) took nonaspirin NSAIDs. Of the 47,050 women in the control group who did not miscarry, 1,213 (2.6 percent) had been exposed to nonaspirin NSAIDs.
"Our study replicates findings from previous studies in animals and one previous study in humans, and has biologic plausibility, which are major steps toward causality," says Anick Berard, Ph.D., Professor, Faculty of Pharmacy at the University of Montreal and Director of the Research Unit on Medications and Pregnancy Research Center at CHU Ste-Justine.
The authors concluded that the use of non-aspirin NSAIDs during early pregnancy was associated with a statistically significant risk of having a spontaneous abortion; therefore, they recommend using them with caution during pregnancy.
Mark Perloe, M.D., a reproductive endocrinologist and medical director of Georgia Reproductive Specialists, says that the study is a case control and not randomized, and while it shows an association, it does not prove that the drugs caused the miscarriages. "The concern is that cramping related to miscarriage was the indication to buy an NSAID and not that the NSAID caused the problem," he explains. "As such, I think minimizing any drug exposure is advisable, but I don’t think this suggests that NSAID’s cause miscarriage."
Still, Dr. Perloe recommends that women avoid NSAIDs around the time of ovulation and if they are pregnant. "I have told people to avoid NSAIDs around ovulation as it may block release of the egg — the evidence is not solid in humans, but in animals, NSAIDs can block ovulation," he says. In addition, stopping NSAIDs six to eight weeks before delivery reduces the possible risk of early closure or constriction of the ductus arteriosus, persistent fetal pulmonary hypertension, intracranial hemorrhages, and renal toxicity in fetuses.
So what should a pregnant woman take if she's suffering a headache or other condition?
"If NSAIDs are used to treat acute conditions such as pain or headache, acetaminophen (Tylenol) is considered a safer alternative," says Dr. Berard. "When NSAIDs are used to treat chronic conditions such as rheumatoid arthritis or lupus, women should carefully plan their pregnancy and discuss treatment options with their physicians. Hence, we recommend avoiding using NSAIDs during the first trimester of pregnancy (increase in risk of miscarriage) if possible. Others have also shown that NSAIDs use during the first or third trimesters of pregnancy increased the risk of birth defects."