Periconceptional Over-the-Counter Nonsteroidal Anti-inflammatory Drug Exposure and Risk for Spontaneous Abortion

University of North Carolina at Chapel Hill, North Carolina, United States
Obstetrics and Gynecology (Impact Factor: 5.18). 07/2012; 120(1):113-22. DOI: 10.1097/AOG.0b013e3182595671
Source: PubMed


To estimate the association between over-the-counter nonsteroidal anti-inflammatory drug (NSAID) exposure during the early first trimester and risk for spontaneous abortion (gestation before 20 weeks of gestation) in a prospective cohort.
Women were enrolled in the Right from the Start study (2004-2010). Exposure data regarding over-the-counter NSAID use from the last menstrual period (LMP) through the sixth week of pregnancy were obtained from intake and first-trimester interviews. Pregnancy outcomes were self-reported and verified by medical records. Gestational age was determined from the LMP. Stage of development before loss was determined from study ultrasonography. Cox proportional hazards regression models were used to estimate the association between NSAID exposure and pregnancy outcome taking into account candidate confounders.
Among 2,780 pregnancies, 367 women (13%) experienced a spontaneous abortion. NSAID exposure was reported by 1,185 (43%) women. NSAID exposure was not associated with spontaneous abortion risk in unadjusted models (hazard ratio [HR] 1.01, 95% confidence interval [CI] 0.82-1.24) or models adjusted for maternal age (adjusted HR 1.00, 95% CI 0.81-1.23).
Our findings suggest that use of nonprescription over-the-counter NSAIDs in early pregnancy does not put women at increased risk of spontaneous abortion.

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    ABSTRACT: Purpose Nonsteroidal anti-inflammatory drugs(NSAIDs) are one of the most common medications reported in pregnancy. NSAIDs directly impact prostaglandin pathways, and have been proposed as potential risk factors for spontaneous abortions(SAB, gestation <20 weeks’). SAB risk and drug response across several medications differ by race; therefore, we evaluated whether associations between NSAIDs and SAB risk differ by race. Methods Women were enrolled the Right from the Start(2004-2010) prospective cohort. Data regarding over-the-counter(OTC) NSAIDs up to the sixth week of pregnancy were obtained from interviews. Race was self-reported. Cox proportional hazards regression models were used to estimate the association between NSAID exposure and SAB, adjusted for confounders. Results Among 2,493 pregnancies, 12% were African American(AA) and 88% were Caucasian(CA). NSAID exposure was reported by 40%(n=124) of AAs, and 43%(n=945) of CAs. Race stratified analyses showed protection from SAB among AAs(adjusted hazard ratio [aHR]=0.84, 95% CI 0.73, 0.96), but no effect in CAs(aHR=1.01, 95% CI 0.88, 1.16). Conclusions Our findings suggest that risk for SAB due to OTC NSAIDs in early pregnancy is modified by race. Further investigation of dose, timing in gestation and indication may help to further reconcile the relationship between race, NSAIDs, and SAB.
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