onaspirin nonsteroidal anti-infammatory drugs (NSAIDs) are oneo the most commonly used medicationsduring pregnancy (17%).
Nevertheless, gesta-tional use o nonaspirin NSAIDs remains contro-versial, partly due to the inconsistency o resultsrom studies on their potential risks, the potentialor residual conounding by comorbidities andthe lack o data on the risks associated with spe-cic types and dosages.
The strongest associa-tion thus ar was seen when nonaspirin NSAIDshad been used close to the time o conception,suggesting bias that could be partly explained bywomen using the drug to alleviate cramping, aprecursor to spontaneous abortion.
No one hasdocumented the risk o spontaneous abortionaccording to type and dosage o nonaspirinNSAIDs — both important elements to considerwhen determining causality.We perormed a nested case–control study toquantiy the risk o spontaneous abortion associ-ated with specic types and dosages o non-aspirin NSAIDs in a cohort o pregnant women,adjusting or potential conounders.
We used a nested case–control study design. Wechose this design because it shows similar eectsizes to a prospective cohort approach with time-varying exposure to medication, but with greatercomputational eciency.
We used data rom the Quebec Pregnancy Reg-istry, an ongoing registry o all pregnancies inQuebec since 1997. Records in the registry are
Use o nonaspirin nonsteroidal anti-infammatory drugsduring pregnancy and the risk o spontaneous abortion
Hamid Reza Nakhai-Pour MD PhD, Perrine Broy BSc, Odile Sheehy MSc, Anick Bérard PhD
Nonedeclared.This article has been peerreviewed.
Dr. Anick Bérard,email@example.com
2011. DOI:10.1503 /cmaj.110454
The association between the useo nonaspirin nonsteroidal anti-infammatorydrugs (NSAIDs) during pregnancy and the risko spontaneous abortion remains unclearbecause o inconsistent research results andthe lack o evidence or an eect due to spe-cic types or dosages o nonaspirin NSAIDs.We aimed to quantiy the associationbetween having a spontaneous abortion andtypes and dosages o nonaspirin NSAIDs in acohort o pregnant women.
Using a nested case–control design,we obtained data rom the Quebec Preg-nancy Registry or 4705 women who had aspontaneous abortion. For each instance, werandomly selected 10 controls rom theremaining women in the registry who werematched by index date (date o the sponta-neous abortion) and gestational age. Use ononaspirin NSAIDs (identied by lled pre-scriptions) and nonuse were compared. Wealso looked or associations between dier-ent types and dosages o nonaspirin NSAIDsand having a spontaneous abortion.Analyseso associations and adjustment or conound-ing were done using conditional logisticregression.
We identied4705 cases o sponta-neous abortion (352 exposed [7.5%]); 47 050controls (1213 exposed [2.6%]). Adjusting orpotential conounders, the use o nonaspirinNSAIDs during pregnancy was signicantlyassociated with the risk o spontaneous abor-tion (odds ratio [OR] 2.43, 95% condenceinterval [CI] 2.12–2.79). Specically, use odicloenac (OR 3.09, 95% CI 1.96–4.87),naproxen (OR 2.64, 95% CI 2.13–3.28), celecoxib(OR 2.21, 95% CI 1.42–3.45), ibuproen (OR2.19, 95% CI 1.61–2.96) and roecoxib (OR 1.83,95% CI 1.24–2.70) alone, and combinationsthereo (OR 2.64, 95% CI 1.59–4.39), were allassociated with increased risk o spontaneousabortion. No dose–response eect was seen.
Gestational exposure to anytype or dosage o nonaspirin NSAIDs mayincrease the risk o spontaneous abortion.These drugs should be used with caution dur-ing pregnancy
© 2011 Canadian Medical Association or its licensors
Early release, published at www.cmaj.ca on September 6, 2011. Subject to revision.