A large study was just published by the Canadian Medical Association Journal on September 6, 2011, called “Use of nonaspirin nonsteroidal anti-inflammatory drugs during pregnancy and the risk of spontaneous abortion” by Nakkahi-Pour and associates. The authors found that common over the counter and prescription pain relievers like Ibuprofen (brand names Motrin, Advil, etc) and diclofenac (Voltaren, Cataflam), naproxen (brand name Alleve, Naprosyn), celecoxib (Celebrex) and rofecoxib (Vioxx) can more than double your risk for miscarriage. These drugs are in a class of agents known as NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), and they are some of the most widely used medications in the world today.
The authors looked at more than 4,700 miscarriages and compared them to normal pregnancies. They found that the use of NSAIDs was much more common in pregnancies that miscarried compared to normal pregnancies. The risk for miscarriage increased from two- to three-fold for the different NSAIDs studied. The authors recommended that pregnant women use these drugs with caution.
Interestingly, these drugs, as well as aspirin, are powerful prostaglandin inhibitors, and fertility doctors often caution against use of these agents because they may interfere with ovulation. Prostaglandins are responsible for allowing the egg to escape from the ovary during ovulation. In addition, when you are trying to conceive, it is probably a good idea to treat your body as if you are already pregnant to avoid exposing an early pregnancy to harm.
Don’t go crazy though. Pregnant women are people too! If you are pregnant and ill, you still deserve treatment for your illness. In fact, going overboard with caution about medications during pregnancy can sometimes cause more harm than good. Many women on chronic medications can put themselves and their pregnancy at risk by suddenly stopping medications as soon as they get a positive on the home pregnancy test. Please do not do this. Please call your doctor before you make any changes. It may be more risky to stop your medications than to continue them.
Ideally, if you are on medications, you plan for a healthy pregnancy by speaking with your doctors before you conceive. Talk to them about trying to conceive and whether or not you should continue your medications, switch to a safer alternative or stop your medications (under supervision) altogether.
Talk with your doctor not only about your prescription medications, but also your non-prescription medications, herbal remedies, diet and supplements. A healthy pregnancy is not necessarily a medication-free pregnancy.
Each person’s situation is different, and your doctor is there to help you make the right decisions for you and your pregnancy.
Serena H. Chen, M.D., is Director of the Division of Reproductive Endocrinology in the Department of Obstetrics and Gynecology at Saint Barnabas Medical Center in New Jersey. Dr. Chen is also the Director of the Ovum Donation (Egg Donation) and Third Party Program at the Institute for Reproductive Medicine and Science at Saint Barnabas.
Dr. Chen is a board certified fertility doctor — she is board certified in Obstetrics and Gynecology and Reproductive Endocrinology. She specializes in hysteroscopy, and has pursued special clinical interests in PCOS (polycystic ovarian syndrome), recurrent miscarriage, PGD (preimplantation genetic diagnosis), and sperm and egg donation. Dr. Chen’s professional interests have evolved considerably over the course of her career as a fertility doctor.