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Feb. 1, 2001 -- A Danish study suggests that taking popular painkillers, such as ibuprofen, during pregnancy does not increase the risk for birth defects or small or premature babies, but may increase the risk of miscarriage.
The research, which is published in the Feb. 3 issue of the British Medical Journal, raises a red flag about the use of a class of painkilling medications known as nonsteroidal anti-inflammatories, or NSAIDs. They include such medications as Aleve, ibuprofen (Advil and Motrin), even aspirin. Many, like aspirin and the ibuprofens, are available over the counter, while others, like Anaprox, are available only by prescription. The medications included in this study were taken in prescription strengths.
NSAIDs are commonly used for pain relief because of their relative safety, lack of side effects, and ability to combat the inflammation that is often associated with painful conditions, such as arthritis and menstrual cramps. Although they are rarely prescribed in the U.S. during pregnancy, the drugs are a staple of many a medicine chest.
Study author Gunnar Lauge Nielsen, MD, tells WebMD that his research confirms previous reports that taking NSAIDs during pregnancy does not appear to lead to birth defects or having an early delivery.
However, the connection between NSAIDs and miscarriage had never before been studied. It was just such a connection that his research uncovered, although it is too early to tell whether taking NSAIDs during pregnancy actually causes miscarriage or whether other factors, such as the medical conditions suffered by the women taking NSAIDs, produced the link. Nielsen is a consultant specialist in internal medicine and gastroenterology at Odder Hospital in Denmark.
Two U.S. experts, Caitlin Fiss, MD, a faculty member in the department of obstetrics and gynecology at Weill-Cornell Medical School in New York, and Andrew Toledo, MD, an assistant clinical professor of obstetrics and gynecology at Emory University in Atlanta, agree that a clear cause-effect relationship between NSAIDs and miscarriage cannot be deduced from this study. However, both would still caution their patients against taking NSAIDs during pregnancy.
Fiss says that NSAIDs already have plenty of effects on the body that are undesirable during pregnancy, including the inhibition of blood clotting. They also do have some effects on development of the fetus.
Nielsen and his team compared more than 17,000 women who were not prescribed any medication during pregnancy to nearly 1,500 women who had filled prescriptions for NSAIDs from the period 30 days before conception to the birth of their child. The researchers also compared about 4,300 women who had miscarriages, of whom 63 had taken NSAIDs during pregnancy, to nearly 30,000 women whose babies were born alive.
Among women who filled prescriptions for NSAIDS, the researchers found no increased risk of having an undergrown baby at full term, a premature baby, or a baby with birth defects. However, miscarriages were more common among women who had filled a prescription for an NSAID in the weeks before the loss.
For women with conditions such as rheumatoid arthritis or lupus, who depend on NSAIDs to live a normal life, Toledo says, "they may have no choice but to take [an NSAID]. If she were my patient, I might [recommend trying to] tough it out with some other drug during the first trimester, when miscarriage is most likely to occur. ... It may be, though, that the benefits of NSAIDs outweigh the potential risks."
Still, Toledo believes in erring on the side of caution. He tells WebMD, "We need to be cautioning our patients ... about any medicines taken while a woman is attempting pregnancy or as soon as she finds out she is pregnant. "... This is going to raise my level of concern so that I'm going to tell my patients who are trying to get pregnant not to take [an NSAID during pregnancy or] ... during that two weeks between ovulation and the first missed period."