NSAIDs and Pregnancy

NSAIDS and Pregnancy 

There has been much speculation that taking NSAIDs during pregnancy increases the risk of spontaneous abortion, especially in the later trimesters. In fact, the FDA states in their Medication Guide for Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in 2012 that: "NSAID medicines should not be used by pregnant women late in their pregnancy".

Now, for the FDA to add a warning on any medication means that there was extensive research 

performed that supported the fact that NSAIDs were not safe during pregnancy. There was a very recent study executed this year which showed some evidence that counters what the medical community has used as guidelines for the past decades. 

Benefits in NSAIDs are fast acting reduction in moderate pain, fever, and inflammation. All the benefits of  NSAIDs would obviously be desirable to pregnant women whom suffer from a surplus of complications due to pregnancy. This study examined 65,457 pregnant woman admitted to an Israeli hospital during 2003 and 2009.The studied showed that from the vast amount of subjects, 8.2% of the women who took NSAIDs  miscarried, and 10% of women who were not exposed to NSAIDs miscarried. This demonstrates primarily that there is not a significant variance between the percent of women that miscarried taking NSAIDs and not taking NSAIDs. Secondly, the results showed the opposite of what has been the popular belief that miscarriage rates are higher in woman who take NSAIDs. The study also analyzed and incorporated risk factors for miscarriages (such as tobacco use, obesity, IVF, uterine malformations, hyper-coagulable conditions, intrauterine contraceptive device) into their statistical data.

Articles from 10 years ago warned the public not to take pain relievers because of their very rare side effects, but in present time its clear that these over the counter drugs can actually be very beneficial in moderation, and when they are not consumed with alcohol. This could be a similar trend in pregnant woman as evident from this study. While I am not suggesting that pregnant woman should all start taking NSAIDs because of this one study,  it is a topic of interest that could be promising research in the future.

Citations: 

Guide, Medication, For, and Non-Steroidal Anti-Inflammatory Drugs (Nsaids). "FDA.gov." Medication Guide for Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) (n.d.): n. pag. US Food and Drug Administration. US Food and Drug Administration, 2012. Web. 2 Dec. 2014. <http://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM106241.pdf>.

"Ibuprofen Won't Harm Your Developing Child." Medical Daily. N.p., 3 Feb. 2014. Web. 03 Dec. 2014. <http://www.medicaldaily.com/ibuprofen-nsaids-during-pregnancy-do-not-increase-risk-miscarriage-previous-research-identifying>.

Ibuprofen vs. Aspirin

In one of the articles we discussed last week we saw a little about the competitive nature of aspirin and ibuprofen and the implication this had on the unique anticoagulant effect of low-dose aspirin (81mg per day, not enteric coated). I thought this was interesting and wanted to explore this a little bit more and look at the proposed mechanism involved.

Both aspirin and ibuprofen target COX-1 on platelets and inhibit the catalytic site which converts arachidonic acid into thromboxane (TX) A2. TXA2 is a potent platelet aggregating agent. The difference between the two NSAIDs is that they bind in two different locations in a competitive manner. More importantly though, is that aspirin has an irreversible effect on the catalytic site whereas ibuprofen’s effect is reversible. As an example, if ibuprofen is taken right before a low dose of aspirin the ibuprofen will leave no room in the COX-1 channel for aspirin. After most of the aspirin is metabolized and the ibuprofen is removed, COX-1 will be reactivated and TXA2 will continue to be synthesized leading to platelet aggregation. If aspirin is taken first, ibuprofen will probably not bind to COX-1, and since aspirin’s effect is irreversible, TXA2 will not be synthesized until new platelets are formed. Below is an image showing the cascade inside the platelet and where aspirin has an effect.

So, can you ever take low-dose aspirin and ibuprofen simultaneously? The FDA recommends taking a single dose of ibuprofen either 8 hours before or 30 minutes after low-dose aspirin to maintain the cardioprotective results.

Sources:

“Concomitant Use of Ibuprofen and Aspirin: Potential for Attenuation of the Anti-Platelet Effect of Aspirin.”http://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM161282.pdf. Food and Drug Administration Science Paper. 8 Sep. 2006. Web. 30 Nov. 2014

Schuijt, MP et al. “The Interaction of Ibuprofen and Diclofenac with Aspirin in Healthy Volunteers.” British Journal of Pharmacology 157.6 (2009): 931–934. PMC. Web. 30 Nov. 2014

Image: Gasparyan, A. Y. et al. J Am Coll Cardiol 2008;51:1829-1843