Maternal non-steroidal anti-inflammatory drug exposure during pregnancy and risk of miscarriage: a systematic review and meta-analysis

Eur J Clin Pharmacol. 2022 Feb;78(2):171-180. doi: 10.1007/s00228-021-03222-w. Epub 2021 Oct 11.

Abstract

Background: Numerous studies have suggested that non-steroidal anti-inflammatory drugs (NSAIDs) might be associated with increased risk of miscarriage. However, these results are conflicting and inconclusive.

Methods: We performed this systematic review and meta-analysis to assess the relationship between NSAIDs exposure and risk of miscarriage. A systematic literature search was conducted to identify relevant studies published from the time of database inception until June 2021.

Results: A total of ten studies involving 207,341 pregnant women were subjected to meta-analysis. There was no statistically significantly increased risk of miscarriage with the use of NSAIDs during pregnancy (OR = 1.37, 95% CI 0.99-1.88, p = 0.057). However, our findings showed that women exposed to NSAIDs around the time of conception were at increased risk of miscarriage (OR 2.32, 95% CI 1.16-4.66, p = 0.018). Furthermore, no significant association between NSAID use and miscarriage was evident during the first trimester of pregnancy (OR = 1, 95% CI = 0.83-1.2, p = 0.996), possibly attributable to the small sample size.

Conclusion: Our findings indicate that NSAID exposure around the time of conception might be a risk factor for miscarriage. Further studies are needed to evaluate whether the risk varies by the type, dosage, or timing of NSAID exposure.

Keywords: NSAID; Pregnancy outcome; Prenatal; Spontaneous abortion.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Abortion, Spontaneous / epidemiology*
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage*
  • Female
  • Fertilization / physiology
  • Humans
  • Pregnancy
  • Pregnancy Trimesters / physiology
  • Risk Factors

Substances

  • Anti-Inflammatory Agents, Non-Steroidal