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Title: Prenatal Use of Nonsteroidal Anti-inflammatory Drugs Significantly Increases Risk of Miscarriage

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BMJ 2003;327:368-71.
08/14/2003 06:30:00 PM
By Joene Hendry

Women who use non-steroidal anti-inflammatory drugs (NSAIDs) during the prenatal months, especially around the time of conception or for more than 1 week, significantly increase their risk of miscarriage, according to a population based cohort study. While these findings need further confirmation, "it may be prudent for physicians and women who are planning to be pregnant to be aware of this potential risk and avoid using NSAIDs around conception," writes epidemiologist De-Kun Li and colleagues from Kaiser Foundation Research Institute, Oakland, California United States. The researchers analysed pregnancy outcomes up to 20 weeks gestation in 1,055 women enrolled in the Kaiser Permanente Medical Care Program in the San Francisco area of northern California. A total of 53 women (5%) reported prenatal NSAID use around the time of conception or during pregnancy. When results were adjusted for confounders, including previous miscarriage, maternal age, gravidity, use of a hot tub, multivitamin use, smoking since last menstruation, education, and race, prenatal NSAID use was associated with an 80% increased risk of miscarriage (hazard ratio [HR] 1.8). Among NSAID users, the HR for risk of miscarriage was 5.6 for use during conception and 1.2 for use after conception. The HR was 1.3 for those who used NSAIDs for less than 1 week, but was 8.1 for those who used NSAIDs for 1 week or longer. Further adjustments for alcohol or coffee drinking during the prenatal period did not change these results. The investigators noted a similar association between increased risk of miscarriage and prenatal aspirin use. Conversely, use of paracetamol during pregnancy was not associated with risk of miscarriage regardless of the timing or duration of use. Among 172 users of paracetamol, compared with 762 non-users, overall HR for the risk of miscarriage was 1.2.

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