Nonsteroidal anti-inflammatory drugs – including aspirin, ibuprofen, naproxen, diclofenac, piroxicam and others – that reduce fever and inflammation do not cause miscarriages, according to a study by Ben-Gurion University of the Negev researchers.

NSAIDs are increasingly used by pregnant women in the first trimester to combat pain, fever and inflammation.

Doctors have been confused about whether taking NSAIDs during pregnancy causes women to lose their fetuses, but many warned against doing so – especially during the early phase of pregnancy – because previous studies have not shown consistent results. This resulted in a lot of illness and suffering among women.

Paracetamon (Acamol), which is widely taken here by children and adults, is not considered an NSAID because while it does reduce fever, it has little effect on inflammation.

Paracetamol indeed treats pain and fever by blocking COX-2 selective inhibitors, which target specific inflammation mostly in the central nervous system but not much in the rest of the body.

But now, Dr. Sharon Daniel and Prof. Amalia Levy, of BGU’s public health department and the nearby Soroka University Medical Center in Beersheba, have confirmed in a large retrospective study that NSAIDs are not risky during pregnancy.

To determine whether there is an association between the use of NSAIDs in pregnancy and miscarriage (spontaneous abortion), researchers looked at data on 65,457 women aged 15 to 45 years who were admitted to Soroka between January 2003 and December 2009 to give birth (90 percent of women) or for a miscarriage (10%).

“We found no important associations between exposure to NSAIDs – either by group or for most specific NSAID drugs – and risk of spontaneous abortion,” the Beersheba researchers wrote.

“However,” they wrote, “we found an increased risk of spontaneous abortion following exposure to indomethacin,” which is an NSAID commonly used as a prescription medication to reduce fever, pain, stiffness and swelling that works by inhibiting the production of prostaglandins, molecules known to cause these symptoms.

The authors believe that this may be due to “reverse causation bias” because indomethacin was dispensed at the end of pregnancy, likely to treat preterm labor, an indication different than that for other NSAIDs.

“The fact that the study was based on a large proportion of the district population, was adjusted to nearly all known risk factors for miscarriages...

and used advanced statistical methods strengthens the validity of the results,” said Levy.

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