NSAID Pain Meds in Pregnancy Might Increase Risk of Miscarriage

by Pregnancy.org Staff

Pain relief medications -- are they a welcome relief during pregnancy or a cause for alarm? There are lots of opinions on the subject which can be overwhelming. We're making this concern easier to digest by laying out the facts so you can decide on your own.

After a day of being on her feet at work, dealing with the non-stop chatter of her co-workers and customers, Kate was now battling a full blown enormous headache. The so-called “morning” sickness had kept her up again last night. She couldn't wait to get home and reach in the medicine cabinet for some relief.

looking contemplatively in medicine cabinetKate should pause, and so should you, before grabbing that stand-by Aleve or Motrin. While 17% of expectant women use these medications, they're not recommended during pregnancy, especially in the first and third trimesters.

Recently, a Canadian study found that the risk of miscarriage more than doubled in women who used any non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) during pregnancy. Given that it has already been shown that use of NSAIDS during early pregnancy increases the risk of major congenital malformations, this news definitely presents a larger caution flag for pregnant patients.

Alternatives to NSAIDS for Pregnant Moms

With hormones surging and an ever-changing physique, you might be tempted to pop a pill to send the aches away. Try these suggestions; they'll help you feel better and preferably medication-free:

Headache: You don't have to be at the mercy of your headaches. Try these tips to prevent or relieve headaches during your pregnancy:

  • Avoid your headache triggers. Keep a log of foods, scents and activities that seem to cause headaches.
  • Eat several small meals throughout the day. Keeping your blood sugar level even with healthy meals and snacks helps hold off headaches.
  • Drink plenty of water. Dehydration seems to make everything more amplified -- pain, headache and eye pain. If you're battling morning sickness, try ice chips or frozen popsicles.
  • Relaxation and aroma therapy: Practice deep breathing, yoga or other calming practices to decrease your stress level.
  • Try a warm compress. Apply a warm towel to your face, eyes and temples or try a cold compress on the back of your neck. Either should grant you some relief.
  • Get plenty of sleep. Fatigue can contribute to headaches. Try to go to bed early during the first trimester, even on weekends.
  • Consider biofeedback. With mind-body techniques you learn to control certain muscle tension, heart rate and blood pressure which can prevent headaches or reduce headache pain.

Cramps and abdominal aches: Your uterus stretching and growing can feel like mild to moderate menstrual cramps. Early in your pregnancy it could be implantation pain -- when your wee babe is snuggling into the womb for a long, cozy stay. [Editor's note: The first three months, severe abdominal pain can be a sign of ectopic pregnancy. This serious condition requires immediate medical attention.]

In most cases, you can reduce the cramps and abdominal aches with:

  • Heat: Try warm compresses, an electric heating pad (use the lowest settings) or a disposable heating pad.
  • Water: A warm bath might relax your muscles. Also drink plenty of water. Six to eight glasses a day will not only keep you hydrated but it might help keep cramping at bay.
  • Increase your fiber and water intake. That sluggish digestive system and constipation in early pregnancy may cause stomach pains and cramping. Counter with fiber-rich foods and extra water.

Joint and ligament pain: The increased weight of your uterus can press against nerves in your abdomen or pelvis and cause pain. Sciatic nerve pain might occur when the hormone relaxin starts to loosen the connections between pelvic joints. Ways to relieve this condition:

  • Exercise regularly and incorporate lots of stretches/stretching into your routine.
  • Stand up or lay down a few minutes.
  • Change your seating and sleeping positions.
  • Visit a chiropractor or physical therapist for a check-up.

Back pain: Back pain during pregnancy shouldn't come as a surprise. You're gaining weight, you're walking in a new way as your center of balance shifts, and your hormones are relaxing the muscles and ligaments throughout your body. Don't just grin and bear it. You can treat or prevent back pain -- there is hope!

  • Practicing good posture by standing up straight, holding your shoulders back and relaxing (not locking) your knees
  • Stretching and exercising regularly strengthens your back and core muscles
  • Wearing shoes that support your insole and padding to help cushion your feet and legs
  • Sitting in chairs that keep your back straight and supported
  • Using a body pillow at night
  • Applying heat to your back, or alternating ice packs with heat
  • Sleeping on your left-side with your knees bent
  • Asking for a back-rub or professional prenatal massage

Questions About the Study

Experts within the field, like Robin Elise Weiss and Cynthia Flynn, suggest that providers and clients carefully weigh the risks and benefits before suggesting a medication during pregnancy. Ibuprofen, one of the NSAIDs, is not recommended for use during pregnancy, especially in the first and third trimesters. Even so, this study might not offer the best evidence that the use of NSAIDs increases the risk of miscarriage.

About the Study: Nkhai-Pour HR, et al "Use of non-aspirin non-steroidal anti-inflammatory drugs during pregnancy and the risk of spontaneous abortion" CMAJ 2011; DOI:10.1503/cmaj.110454.  French and Canadian researchers evaluated 4705 miscarriage cases up to the 20th week of pregnancy. They were matched with 47,050 controls who did not have a miscarriage. The investigators found that the risk of miscarriage in women who used any non-steroidal anti-inflammatory drugs during pregnancy more than doubled (2.43) compared with women who did not use NSAIDs. The authors found no association between dosage and miscarriage.

Problems with the study:

  • Did the control group also take NSAID's? In Canada, most NSAIDs are available by prescription only, but that doesn't rule out that some women in the control group had access to these medicines.
  • Did the women take the medicine? The study looks through a registry, pulls out pregnancies that ended in a miscarriage and then tries to find out if the mother filled a prescription for one of the non-aspirin NSAIDs, not if they actually took it.
  • Why was a NSAID prescribed? It's possible that the condition or disease treated with the NSAID may affect results.
  • Miscarriages that were not clinically detected were excluded. Including women who lost their baby before a first appointment might significantly change the results.

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