Use of over-the-counter medications during pregnancy

Aspirin Use and Miscarriage Risk

BACKGROUND

Recent research has found nonsteroidal antiinflammatory drugs, including aspirin, to increase the risk of miscarriage. The objective of the present study was to evaluate the association between aspirin use and miscarriage.

METHODS

We conducted a case-control study using data from the Collaborative Perinatal Project. This prospective cohort study recruited approximately 54,000 pregnant women at 12 sites in the United States from 1959 to 1965. Women who had miscarriages (n = 542) were matched by clinic and time in pregnancy when they came under observation to 2587 women who had live births. Participants were interviewed at each prenatal visit. Data on aspirin use were collected prospectively by in-person interviews and medical record review. Aspirin use among controls was considered only for the duration of pregnancy when the matched cases remained pregnant. The outcome of interest was miscarriage, defined as spontaneous pregnancy loss at less than 140 days from the last menstrual period.

RESULTS

Twenty-nine percent of cases and 34% of controls used aspirin during pregnancy. Aspirin use was not associated with an increased risk of miscarriage. Adjusted odds ratios ranged from 0.64 to 0.92 (95% confidence intervals = 0.48-1.38) for individual lunar months and combinations of lunar months.

CONCLUSIONS

Use of aspirin during pregnancy is not associated with an increased risk of miscarriage.

Drug prescription patterns before, during and after pregnancy for chronic, occasional and pregnancy-related drugs in the Netherlands

OBJECTIVE

To compare the prescription of drugs in women over a period from 2 years before until 3 months after pregnancy, regarding the type of drugs used and the fetal risk.

DESIGN

A cohort study based on pharmacy records of women giving birth to a child between 1994 and 2003.

SETTING

The study was performed with data from the InterAction database, containing prescription-drug-dispensing data from community pharmacies.

POPULATION

The study population included 5412 women for whom complete pharmacy records were available.

METHODS

Drugs were classified into three categories: (1) drugs for chronic conditions, (2) drugs for occasional use and (3) drugs for pregnancy-related symptoms and also classified according to the Australian classification system.

MAIN OUTCOME MEASURES

The prescription rate was calculated as the number of women per 100 women who received one or more prescriptions for a given drug within a specified time period.

RESULTS

About 79.1% of the women received at least one prescription during pregnancy. The prescription rate for most drugs for chronic diseases and for occasional use decreased during pregnancy, whereas, as expected, the prescription rate for pregnancy-related drugs increased. During the first trimester of pregnancy, 1.7% of all drugs prescribed for chronic conditions and 2.3% of the occasional drugs were classified as harmful.

CONCLUSIONS

The increase in prescription rate during pregnancy is caused by an increase in prescription rate of drugs for pregnancy-related symptoms. The prescription of harmful drugs is more commonly associated with drugs for occasional use rather than with drugs for chronic conditions. Therefore, a more cautious prescribing of drugs to healthy women in the fertile age is necessary.

New insights into spontaneous intestinal perforation using a national data set: (2) two populations of patients with perforations

BACKGROUND

Spontaneous intestinal perforation (SIP) is increasingly common in the premature infant and has been demonstrated to be associated with early postnatal administration of glucocorticoids and indomethacin. Before survival of the extremely low birth weight (ELBW) infant, SIP was thought to be a rare, congenitally acquired disease sporadically affecting the muscularis of the distal intestine. These disparate views of etiology have not been previously reconciled in the literature.

OBJECTIVES

(1) To establish a cohort of SIP patients in a national data set. (2) To use timing of diagnosis as a unique data element and thereby differentiate between SIP cases which are susceptible to postnatal risk factors versus those occurring at or immediately after birth (and therefore not exposed to postnatal risk factors).

METHODS

A large identified national data set was used to retrospectively look at timing of diagnosis and then the cohort was divided into postnatal treatment groups for further subanalyses. This analysis resulted in the division of the cohort into early and late diagnosis SIP subcohorts. These were then queried retrospectively by univariate analysis to look for differences in demographics between the two (using a P-value < 0.05).

RESULTS

There were 633 patients with SIP evaluated in this data set. The early SIP cohort (0-3 days) was made up of 116 infants with a median BW of 1.401 kg, whereas the late cohort (4-14 days) held 386 infants with a median BW of 775 g. Infants with early SIP were significantly more likely to: be male, have higher Apgar scores, have not received antenatal steroids, surfactant or required mechanical ventilation.

CONCLUSIONS

Two populations of infants acquire SIP: ELBW infants acquire SIP on average between 7 and 10 days of life after exposure to indomethacin and glucocorticoids (either endogenous or exogenous), and infants with early SIP (0-3 days) who are significantly less likely to have been exposed to postnatal risk factors and are less premature.