Periconceptional Over-the-Counter Nonsteroidal Anti-inflammatory Drug Exposure and Risk for Spontaneous Abortion

Edwards, Digna R. Velez PhD; Aldridge, Tiara BA; Baird, Donna D. PhD, MPH; Funk, Michele Jonsson PhD; Savitz, David A. PhD; Hartmann, Katherine E. MD, PhD

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e3182595671
Original Research
Journal Club
Abstract

OBJECTIVE: To estimate the association between over-the-counter nonsteroidal anti-inflammatory drug (NSAID) exposure during the early first trimester and risk for spontaneous abortion (gestation before 20 weeks of gestation) in a prospective cohort.

METHODS: Women were enrolled in the Right from the Start study (2004–2010). Exposure data regarding over-the-counter NSAID use from the last menstrual period (LMP) through the sixth week of pregnancy were obtained from intake and first-trimester interviews. Pregnancy outcomes were self-reported and verified by medical records. Gestational age was determined from the LMP. Stage of development before loss was determined from study ultrasonography. Cox proportional hazards regression models were used to estimate the association between NSAID exposure and pregnancy outcome taking into account candidate confounders.

RESULTS: Among 2,780 pregnancies, 367 women (13%) experienced a spontaneous abortion. NSAID exposure was reported by 1,185 (43%) women. NSAID exposure was not associated with spontaneous abortion risk in unadjusted models (hazard ratio [HR] 1.01, 95% confidence interval [CI] 0.82–1.24) or models adjusted for maternal age (adjusted HR 1.00, 95% CI 0.81–1.23).

CONCLUSION: Our findings suggest that use of nonprescription over-the-counter NSAIDs in early pregnancy does not put women at increased risk of spontaneous abortion.

LEVEL OF EVIDENCE: II

In Brief

Spontaneous abortion is not associated with periconceptional exposure to over-the-counter nonsteroidal anti-inflammatory drugs.

Author Information

From the Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Department of Obstetrics and Gynecology, and the Center for Human Genetics Research, Vanderbilt University, Nashville, Tennessee; the Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina; the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; and the Departments of Epidemiology and Obstetrics and Gynecology, Brown University, Providence, Rhode Island.

The field research was supported by grants from the National Institute of Child and Human Development (R01HD043883 and R01HD049675) and the American Water Works Association Research Foundation (2579). Additional funds were provided by the Building Interdisciplinary Research Careers in Women's Health career development program (K12HD4383) supported in part by the Vanderbilt CTSA grant UL1 RR024975-01 from National Center for Research Resources/National Institutes of Health and the Agency for Healthcare Research and Quality (K02HS017950). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. This research was also supported in part by the Intramural Research Program of the National Institutes of Health, National Institute of Environmental Health Sciences (ie, support for coauthor Donna D. Baird).

Corresponding author: Digna R. Velez Edwards, PhD, Vanderbilt Epidemiology Center, 2525 West End Avenue, Suite 600, 6th Floor, Nashville, TN 37203; e-mail: digna.r.velez.edwards@vanderbilt.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2012 The American College of Obstetricians and Gynecologists