Painkillers increase risk of miscarriage: doctors
The Daily Excelsior
Sunday, September 7, 2003
Indraprasth, Sept 7 - Pregnant women should avoid taking
the painkiller Ibuprofen and other non-steroidal anti-
inflammatory drugs for headaches during pregnancy as they
dramatically increase the risk of miscarriage, doctors
have warned.
Quoting the latest international reseach linking nsaids
and aspirin with increased risk of miscarriage, Dr
Suneeta Mittal, Head of the Department of Obstetrics and
Gynaecology at All India Institute of Medical Sciences
said patients should avoid use of these drugs especially
during the peri-conceptual period through the first few
months of pregnancy.
The research published in the british medical journal
revealed that women who took Ibuprofen had almost double
the incidence of miscarriage while aspirin and other
nsaids were also linked to an increased danger.
The risk was higher when the drugs were taken around the
time the baby was conceived or when these drugs were used
for more than a week at a stretch. However, women who
took paracetamol during this period reported no such
symptoms.
"Nsaids should be avoided in pregnancy. Usually
paracetamol is the first line treatment for pain, fever
and headache. Low dose aspirin may be advisable for
specific conditions like anti-phospho-lipid syndrome or
vascular thrombosis. But generally, for any normal
pregnancy cases, no drug should be used without doctor’s
advice," she said.
According to Dr Mittal, approximately 10 to 15 per cent
pregnancies end in spontaneous abortions but a recent
study has linked wrong medication to a higher risk of
miscarriage, although the results need to be established
on a larger scale.
The research conducted by the US-based Kaiser Foundation
Research Institute revealed the side-effect of nsaids and
aspirin but found paracetamol was safe safe during
pregnancy and did not cause miscarriage before 20 weeks
of gestation.
The use of nsaids increased the risk of miscarriage by 80
per cent, the study found. Aspirin was also linked with
an increased risk of miscarriage, although the number of
aspirin users was too less to establish a clear link.
Paracetamol, which shares many of the indications for use
with nsaids but has a different underlying
pharmacological effect, did not increase the risk of
miscarriage.
Taking the study seriously, obstetricians and
gynaecologists felt that it could be very useful in
establishing guidelines of treatment protocols to prevent
miscarriages during pregnancy.
This was significant in light of the fact that incidence
of miscarriages in India is very high and majority goes
unreported. Furthermore, use of nsaids like ibuprofen and
nimesulide and even of aspirin as painkillers was very
common.
Senior consultant gynaecologist at Apollo hospital Dr
Anita G. Kaul said, "I am surprised that there is such a
high figure of 80 per cent probability of miscarriage by
the use of nsaids. Paracetamol has always been the first
line treatment for managing pains in pregnancy. Besides,
I had frequently been prescribing lower doses of aspirin
to pregnant women. But now after going through this
study, I am only recommending paracetamol as a safer drug
than any other."
In India where even much stronger nsaids like nimesulide
was frequently and commonly used as a pain-killer, the
result of this study was very important. She felt that
doctors should put in all efforts to warn people about
the health hazards the wrong selection of pain-killers
could cause.
"Taking a tip from here, we should be able to educate our
specialists and women folk to make them aware of safe
medication during pregnancy and to avoid unnecessary
pain-killers for a safer pregnancy."
According to the research, the probable underlying
mechanism was that nsaids and aspirin suppress the
production of fatty acids called prostaglandins, which
are needed for successful implantation of an embryo in
the womb.
Without a healthy placenta, the risk of foetal demise can
increase greatly. Suppression of prostaglandin
biosynthesis by nsaids in peripheral tissues, including
those of the reproductive system, could therefore lead to
abnormal implantation that predisposes an embryo to
miscarriage.
Use of paracetamol during pregnancy was not associated
with risk of miscarriage regardless of the timing or
duration of use. Paracetamol shares many of the
indications for use with nsaids but has a different
underlying pharmacological effect.
Whereas nsaids and aspirin act on the whole body,
paracetamol acts only in the central nervous system.
Perhaps this is why paracetamol does not increase the
risk of miscarriage, as it does not affect the
reproductive system.
The researchers at Kaiser foundation, US had interviewed
1055 pregnant women immediately after their pregnancy was
confirmed. Five per cent reported prenatal nsaid use
around the time of conception or during pregnancy, while
another 22 had taken aspirin. (UNI)
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