Do Painkillers Cause Miscarriage?

Do common painkillers such as aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) cause miscarriage? A recent study by a group of medical researchers in the United States found no evidence that links miscarriages with use of over-the-counter painkillers during early pregnancy.

“Our findings suggest that use of nonprescription over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) in early pregnancy does not put women at increased risk of spontaneous abortion,” note the researchers in their conclusion.

They arrived at said conclusion by interviewing nearly 3000 pregnant women who were part of the Right from the Start cohort study about their medication exposure as well as their pregnancy outcomes.

The researchers found that “thirteen percent of all women suffered a miscarriage during the study but the risk was no greater for women who’d used NSAIDs, regardless of the number of days they took the drugs.” [via Reuters]

There are important things that are worth underscoring in the case of this research. First, is that the conclusion above is only applicable for over-the-counter painkillers and should not be assumed to also apply for pain drugs that are prescribed by doctors.

Second is that the researchers themselves, because of the non-clinical nature of the study, admit that they cannot say with certainty that it is safe for pregnant women to take painkillers, whether over-the-counter or otherwise.

“We can never know whether NSAIDs or any other medication are completely safe for pregnant women,” study lead author Digna Velez Edwards from Vanderbilt University in Nashville tells Reuters Health in an interview. [Other researchers
for the study (entitled Periconceptional Over-the-Counter Nonsteroidal Anti-inflammatory Drug Exposure and Risk for Spontaneous Abortion) include Aldridge, Tiara BA; Baird, Donna D. PhD, MPH; Funk, Michele Jonsson PhD; Savitz, David A. PhD; Hartmann, Katherine E. MD, PhD.]

To date the findings by other researchers, such as the ones below, on whether painkillers are associated with miscarriages or spontaneous miscarriages is not what one would call conclusive:

Use of nonaspirin nonsteroidal anti-inflammatory drugs during pregnancy and the risk of spontaneous abortion by Nakhai-Pour HR, Broy P, Sheehy O, Bérard A: Gestational exposure to any type or dosage of nonaspirin NSAIDs may increase the risk of spontaneous abortion. These drugs should be used with caution during pregnancy.

Risk of adverse birth outcome and miscarriage in pregnant users of non-steroidal anti-inflammatory drugs: population based observational study and case-control study by Nielsen GL, Sørensen HT, Larsen H, Pedersen L: Use of non-steroidal anti-inflammatory drugs during pregnancy does not seem to increase the risk of adverse birth outcome but is associated with increased risk of miscarriage.

Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: population based cohort study
by Li DK, Liu L, Odouli R: Prenatal use of NSAIDs and aspirin increased the risk of miscarriage. These findings need confirmation in studies designed specifically to examine the apparent association.

So these researches really don’t clarify things, no? They don’t tell us whether women should or should not continue to use painkillers when they are pregnant. Well, that may be true but research findings like these are never meant to replace the advise of your doctors. So do consult your doctor if you should take that aspirin or not.

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