NSAIDS and Risk of Miscarriage

MedicalResearch.com Interview with:
Dr. Sharon Daniel MD, MPH
Physician, Intern in pediatrics at Soroka Medical Center, Beer-Sheva, Israel
PhD Candidate
and
Prof. Amalia Levy (MPH, PhD
Epidemiologist, Head of the Department of Public Health
Principle Investigator.
Ben-Gurion University of the Negev in Beer-Sheva, Israel,

MedicalResearch.com: What are the main findings of the study?

Answer: We tested the risk for miscarriage following the use of NSAIDs (ibuprofen, diclofenac, naproxen, indomethacin, etodolac) on the first trimester of pregnancy. We did not find increased risk among women who took those drugs during the first trimester of pregnancy, although we did find increased risk after the use of indomethacin. We found higher risk after the use of specific NSAIDs (Celecoxib, Rofecoxib, Etoricoxib) which are usually used to treat inflammatory diseases, only the exposure group was very small.

MedicalResearch.com: Were any of the findings unexpected?

Answer: We did not expect to find higher risk following the use of indomethacin. We believe that this specific result is actually caused by a bias because indomethacin is usually given by gynecologists to treat preterm labor. We think, and our results also show, that women used indomethacin because of an impending miscarriage and that the drug itself is not a risk factor.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer: NSAIDs are increasingly used mostly for fever and pain by both clinicians and patients. Our study shows that their use during the first trimester does not increase the risk for miscarriage.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer: As the use of NSAIDs is increasing during pregnancy we recommend that further studies, with larger exposure groups, will be performed to assess the risk following the use of COX2 inhibitors (Celecoxib, Etoricoxib). We believe that the answer to this question is sought by many women who suffer from inflammatory diseases and wish to conceive.

Citation:

Note:
The study was performed in collaboration with Prof. Gideon Koren, Motherisk program, division of clinical pharmacology and toxicology, hospital for sick children,the university of Toronto (BeMORE- Ben-Gurion Motherisk obstetric registry of exposure collaboration)

Citation:

Fetal exposure to nonsteroidal anti-inflammatory drugs and spontaneous abortions

CMAJ cmaj.130605; published ahead of print February 3, 2014, doi:10.1503/cmaj.130605 Sharon Daniel, Gideon Koren, Eitan Lunenfeld, Natalya Bilenko, Ronit Ratzon,and Amalia Levy