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Zafeiri A, Raja EA, Mitchell RT, Hay DC, Bhattacharya S, Fowler PA. Maternal over-the-counter analgesics use during pregnancy and adverse perinatal outcomes: cohort study of 151 141 singleton pregnancies. BMJ Open 2022; 12:e048092. [PMID: 35504638 PMCID: PMC9066494 DOI: 10.1136/bmjopen-2020-048092] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/07/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To identify any associations between in utero exposure to five over-the-counter (non-prescription) analgesics (paracetamol, ibuprofen, aspirin, diclofenac, naproxen) and adverse neonatal outcomes. DESIGN Retrospective cohort study using the Aberdeen Maternity and Neonatal Databank. PARTICIPANTS 151 141 singleton pregnancies between 1985 and 2015. MAIN OUTCOME MEASURES Premature delivery (<37 weeks), stillbirth, neonatal death, birth weight, standardised birthweight score, neonatal unit admission, APGAR score at 1 and 5 min, neural tube and amniotic band defects, gastroschisis and, in males, cryptorchidism and hypospadias. RESULTS 83.7% of women taking over-the-counter analgesics reported first trimester use when specifically asked about use at their first antenatal clinic visit. Pregnancies exposed to at least one of the five analgesics were significantly independently associated with increased risks for premature delivery <37 weeks (adjusted OR (aOR)=1.50, 95% CI 1.43 to 1.58), stillbirth (aOR=1.33, 95% CI 1.15 to 1.54), neonatal death (aOR=1.56, 95% CI 1.27 to 1.93), birth weight <2500 g (aOR=1.28, 95% CI 1.20 to 1.37), birth weight >4000 g (aOR=1.09, 95% CI 1.05 to 1.13), admission to neonatal unit (aOR=1.57, 95% CI 1.51 to 1.64), APGAR score <7 at 1 min (aOR=1.18, 95% CI 1.13 to 1.23) and 5 min (aOR=1.48, 95% CI 1.35 to 1.62), neural tube defects (aOR=1.64, 95% CI 1.08 to 2.47) and hypospadias (aOR=1.27, 95% CI 1.05 to 1.54 males only). The overall prevalence of over-the-counter analgesics use during pregnancy was 29.1%, however it rapidly increased over the 30-year study period, to include over 60% of women in the last 7 years of the study. This makes our findings highly relevant to the wider pregnant population. CONCLUSIONS Over-the-counter (non-prescription) analgesics consumption during pregnancy was associated with a substantially higher risk for adverse perinatal health outcomes in the offspring. The use of paracetamol in combination with other non-steroidal anti-inflammatory drugs conferred the highest risk. The increased risks of adverse neonatal outcomes associated with non-prescribed, over-the-counter, analgesics use during pregnancy indicate that healthcare guidance for pregnant women regarding analgesic use need urgent updating.
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Affiliation(s)
- Aikaterini Zafeiri
- Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Edwin Amalraj Raja
- Medical Statistics Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Rod Thomas Mitchell
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - David C Hay
- MRC Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, UK
| | - Sohinee Bhattacharya
- Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Paul A Fowler
- Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Escañuela Sánchez T, Meaney S, O'Donoghue K. Modifiable risk factors for stillbirth: a literature review. Midwifery 2019; 79:102539. [PMID: 31585399 DOI: 10.1016/j.midw.2019.102539] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/12/2019] [Accepted: 09/21/2019] [Indexed: 12/22/2022]
Abstract
A stillbirth is defined as an infant born weighing 500 g and/or more or at a gestational age of 24 weeks who shows no signs of life. Having a stillborn baby has a wide range of consequences that can affect parents, family and the healthcare professionals involved. Several risk factors have been associated with an increased risk of stillbirth: including maternal medical factors, maternal characteristics, fetal factors, sociodemographic factors and behavioral factors. The aim of this work is to review the literature on risk factors that have a behavioral component. The main behaviors modulating the risk of stillbirth that have been more widely studied in the literature include use of substances (smoking, alcohol, illicit drugs and medical drugs), weight management, attendance at antenatal care and sleeping position. There is evidence in the literature that supports that all those behaviors have an impact on the risk of stillbirth, especially in the cases of smoking and drugs consumption during the pregnancy. Hence, more research is needed to establish interventions targeting these behaviors as preventive measures to reduce the risk of adverse obstetric outcomes.
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Affiliation(s)
- Tamara Escañuela Sánchez
- INFANT Research Centre, Ireland; Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Ireland.
| | - Sarah Meaney
- National Perinatal Epidemiology Centre (NPEC), University College Cork, Ireland; Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Ireland.
| | - Keelin O'Donoghue
- INFANT Research Centre, Ireland; Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Ireland.
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Kristensen DM, Mazaud-Guittot S, Gaudriault P, Lesné L, Serrano T, Main KM, Jégou B. Analgesic use - prevalence, biomonitoring and endocrine and reproductive effects. Nat Rev Endocrinol 2016; 12:381-93. [PMID: 27150289 DOI: 10.1038/nrendo.2016.55] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Paracetamol and NSAIDs, in particular acetylsalicylic acid (aspirin) and ibuprofen, are among the most used and environmentally released pharmaceutical drugs. The differences in international trends in the sale and consumption of mild analgesics reflect differences in marketing, governmental policies, habits, accessibility, disease patterns and the age distribution of each population. Biomonitoring indicates ubiquitous and high human exposure to paracetamol and to salicylic acid, which is the main metabolite of acetylsalicylic acid. Furthermore, evidence suggests that analgesics can have endocrine disruptive properties capable of altering animal and human reproductive function from fetal life to adulthood in both sexes. Medical and public awareness about these health concerns should be increased, particularly among pregnant women.
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Affiliation(s)
- David M Kristensen
- Genomic and Molecular Biomedicine, Department of Biology, University of Copenhagen, Ole Maaløes Vej 5, DK-2200 Copenhagen N, Denmark
| | - Séverine Mazaud-Guittot
- Institut national de la santé et de la recherche médicale (Inserm), Institut de recherche en santé, environnement et travail (Irset-Inserm UMR 1085), 9 Avenue Léon Bernard, F-35042 RENNES, France
| | - Pierre Gaudriault
- Institut national de la santé et de la recherche médicale (Inserm), Institut de recherche en santé, environnement et travail (Irset-Inserm UMR 1085), 9 Avenue Léon Bernard, F-35042 RENNES, France
| | - Laurianne Lesné
- Institut national de la santé et de la recherche médicale (Inserm), Institut de recherche en santé, environnement et travail (Irset-Inserm UMR 1085), 9 Avenue Léon Bernard, F-35042 RENNES, France
| | - Tania Serrano
- Institut national de la santé et de la recherche médicale (Inserm), Institut de recherche en santé, environnement et travail (Irset-Inserm UMR 1085), 9 Avenue Léon Bernard, F-35042 RENNES, France
- Ecole des hautes études en santé publique (EHESP), Avenue Léon Bernard, F-35043 RENNES, France
| | - Katharina M Main
- Department of Growth and Reproduction, University of Copenhagen, Section GR5064, Blegdamsvej 9, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Bernard Jégou
- Institut national de la santé et de la recherche médicale (Inserm), Institut de recherche en santé, environnement et travail (Irset-Inserm UMR 1085), 9 Avenue Léon Bernard, F-35042 RENNES, France
- Ecole des hautes études en santé publique (EHESP), Avenue Léon Bernard, F-35043 RENNES, France
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Dreier JW, Andersen AMN, Berg-Beckhoff G. Systematic review and meta-analyses: fever in pregnancy and health impacts in the offspring. Pediatrics 2014; 133:e674-88. [PMID: 24567014 DOI: 10.1542/peds.2013-3205] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Fever during pregnancy has been suspected to harm the developing fetus. However, until now, no systematic analysis of the available evidence has been undertaken to assess the impact of maternal fever on health outcomes in the child. The goal of this study was to systematically review evidence from epidemiologic studies on adverse health outcomes of the offspring in relation to exposure to maternal fever during pregnancy. METHODS Systematic searches in PubMed, Web of Science, and the Cochrane Library were performed by using Medical Subject Headings, Boolean operators, and truncation, and references of references were reviewed. Cohort and case-control studies addressing health outcomes of prenatal fever exposure in humans were eligible for inclusion. Studies with no direct reference to fever, studies in selected populations (eg, preterm births), and studies published before 1990 were excluded. RESULTS The available literature supported an increased risk of adverse offspring health in association with fever during pregnancy. The strongest evidence was available for neural tube defects, congenital heart defects, and oral clefts, in which meta-analyses suggested between a 1.5- and nearly 3-fold increased risk with fever exposure in the first trimester. We did not find strong evidence of a dose-response relationship, but there was some evidence that antipyretic medications may have a protective effect when used in relation to febrile episodes. CONCLUSIONS We found substantial evidence to support the contention that maternal fever during pregnancy may negatively affect offspring health. The harmful effects seemed to cover both short- and longer-term health outcomes; however, for several outcomes, the evidence was insufficient to judge any association.
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Thiele K, Kessler T, Arck P, Erhardt A, Tiegs G. Acetaminophen and pregnancy: short- and long-term consequences for mother and child. J Reprod Immunol 2013; 97:128-39. [PMID: 23432879 DOI: 10.1016/j.jri.2012.10.014] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 10/15/2012] [Indexed: 02/05/2023]
Abstract
Counter-intuitively, over-the-counter medication is commonly taken by pregnant women. In this context, acetaminophen (APAP, e.g. Paracetamol, Tylenol) is generally recommended by physicians to treat fever and pain during pregnancy. Thus, APAP ranks at the top of the list of medications taken prenatally. Insights on an increased risk for pregnancy complications such as miscarriage, stillbirth, preterm birth or fetal malformations upon APAP exposure are rather ambiguous. However, emerging evidence arising from human trials clearly reveals a significant correlation between APAP use during pregnancy and an increased risk for the development of asthma in children later in life. Pathways through which APAP increases this risk are still elusive. APAP can be liver toxic and since APAP appears to freely cross the placenta, therapeutic and certainly toxic doses could not only affect maternal, but also fetal hepatocytes. It is noteworthy that during fetal development, the liver transiently functions as the main hematopoietic organ. We here review the effect of APAP on metabolic and immunological parameters in pregnant women and on fetal development and immune ontogeny in order to delineate novel, putative and to date underrated pathways through which APAP use during pregnancy can impair maternal, fetal and long term children's health. We conclude that future studies are urgently needed to reconsider the safety and dosage of APAP during pregnancy and - based on the advances made in the field of reproduction as well as APAP metabolism - we propose pathways, which should be addressed in future research and clinical endeavors.
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Affiliation(s)
- Kristin Thiele
- Laboratory for Experimental Feto-Maternal Medicine, Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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STACEY T, THOMPSON JM, MITCHELL EA, EKEROMA AJ, ZUCCOLLO JM, MCCOWAN LM. The Auckland Stillbirth study, a case-control study exploring modifiable risk factors for third trimester stillbirth: methods and rationale. Aust N Z J Obstet Gynaecol 2010; 51:3-8. [DOI: 10.1111/j.1479-828x.2010.01254.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Houston LE, Odibo AO, Macones GA. The safety of obstetrical ultrasound: a review. Prenat Diagn 2009; 29:1204-12. [DOI: 10.1002/pd.2392] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Affiliation(s)
- RL Goldenberg
- Department of Obstetrics and Gynecology and the School of Public Health University of Alabama at Birmingham Birmingham Alabama USA
| | - R Kirby
- The School of Public Health Birmingham Alabama USA
| | - JF Culhane
- Department of Obstetrics and Gynecology Drexel University Philadelphia Pennsylvania USA
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Torloni MR, Vedmedovska N, Merialdi M, Betrán AP, Allen T, González R, Platt LD. Safety of ultrasonography in pregnancy: WHO systematic review of the literature and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:599-608. [PMID: 19291813 DOI: 10.1002/uog.6328] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE In the context of the planned International Society of Ultrasound in Obstetrics and Gynecology-World Health Organization multicenter study for the development of fetal growth standards for international application, we conducted a systematic review and meta-analysis to evaluate the safety of human exposure to ultrasonography in pregnancy. METHODS A systematic search of electronic databases, reference lists and unpublished literature was conducted for trials and observational studies that assessed short- and long-term effects of exposure to ultrasonography, involving women and their fetuses exposed to ultrasonography, using B-mode or Doppler sonography during any period of pregnancy, for any number of times. The outcome measures were: (1) adverse maternal outcome; (2) adverse perinatal outcome; (3) abnormal childhood growth and neurological development; (4) non-right handedness; (5) childhood malignancy; and (6) intellectual performance and mental disease. RESULTS The electronic search identified 6716 citations, and 19 were identified from secondary sources. A total of 61 publications reporting data from 41 different studies were included: 16 controlled trials, 13 cohort and 12 case-control studies. Ultrasonography in pregnancy was not associated with adverse maternal or perinatal outcome, impaired physical or neurological development, increased risk for malignancy in childhood, subnormal intellectual performance or mental diseases. According to the available clinical trials, there was a weak association between exposure to ultrasonography and non-right handedness in boys (odds ratio 1.26; 95% CI, 1.03-1.54). CONCLUSION According to the available evidence, exposure to diagnostic ultrasonography during pregnancy appears to be safe.
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Affiliation(s)
- M R Torloni
- Department of Obstetrics, São Paulo Federal University and Brazilian Cochrane Center, São Paulo, Brazil.
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Rebordosa C, Kogevinas M, Bech BH, Sorensen HT, Olsen J. Use of acetaminophen during pregnancy and risk of adverse pregnancy outcomes. Int J Epidemiol 2009; 38:706-14. [DOI: 10.1093/ije/dyp151] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
AIM This paper presents an overview of current literature relating to over-the-counter and herbal preparations use, with a focus on pregnancy. BACKGROUND Internationally, there has been a shift towards self-medication through over-the-counter release of many prescription-category drugs and wider acceptance and use of herbal preparations. The general community perception that these preparations are safe may lead to inappropriate use, especially during pregnancy. METHOD A range of databases was searched to identify papers addressing 'over-the-counter preparations/medications', 'non-prescription medications', 'herbal preparations' and 'pregnancy', including Medline, Cumulative Index to Nursing, Allied Health Literature, Proquest and Sciencedirect. Midwifery, nursing and scientific papers published from 2000 onwards were included, along with a small number of scientific papers published from 1995 onwards, and some key textbooks to clarify the definitions. FINDINGS Pregnant women use a range of over-the-counter preparations, including analgesics, antihistamines, antacids and a variety of herbal preparations. However, in many cases, it is unclear whether their use is actually safe in the short- or long-term for mother or baby, owing to an inadequate evidence-base to support the use of these preparations during pregnancy. CONCLUSION While there is extensive literature on the use of over-the-counter preparations generally, less is available about their use in pregnancy. Further research is needed to explore the prevalence of use and effects of these preparations in pregnancy and neonatal outcomes, and to support midwives and nurses in harm minimization through the promotion of informed risk-avoidance behaviours.
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Affiliation(s)
- Lisa McKenna
- School of Nursing and Midwifery, Monash University, Peninsula Campus, Frankston, Victoria, Australia.
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Sweetman B, Considine J. Case review: septic shock in the pregnant patient. ACTA ACUST UNITED AC 2004; 12:141-8. [PMID: 15234711 DOI: 10.1016/j.aaen.2004.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2004] [Accepted: 02/11/2004] [Indexed: 11/20/2022]
Abstract
This case study involves a 36-year-old female at 15 weeks gestation who presented with severe lower abdominal pain post amniocentesis and subsequently deteriorated into a state of septic shock whilst in the ED. The circumstances surrounding this patient's presentation and subsequent clinical course are presented. The assessment and management of septic shock is also described with specific consideration to this patient's pregnant state.
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Affiliation(s)
- Brian Sweetman
- Emergency Department, The Northern Hospital, 185 Cooper St, Epping, 3076, Victoria, Australia.
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Buck GM, Johnson CD. Methodologic considerations for population-based research on fetal deaths: overcoming data gaps. Semin Perinatol 2002; 26:31-5. [PMID: 11876565 DOI: 10.1053/sper.2002.29837] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fetal deaths comprise a large component of perinatal mortality and remain an understudied pregnancy outcome, especially from a population perspective. Interpretation of the findings from clinical or community-based studies can be difficult without a clear understanding of fetal death at the population level. This article addresses the critical data gaps underlying population-based research on fetal deaths, including the magnitude and scope of the problem, the probability of occurrence, the populations at risk, and the importance of accounting for prior reproductive history. Suggestions are given for new avenues of population-based research such as prospective inquiry of couples attempting pregnancy and newer analytic and modeling strategies for assessing risk and for addressing the lack of independence in pregnancy outcomes.
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Affiliation(s)
- Germaine M Buck
- National Institute of Child Health and Human Development, Epidemiology Branch, Rockville, MD 20852, USA.
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Emanuel I, Leisenring W, Williams M, Kimpo C, Estee S, O'Brien W, Hale CB. Authors' reply to the commentary Maternal birthweight and newborn status. Paediatr Perinat Epidemiol 2000; 14:378-80. [PMID: 11101026 DOI: 10.1046/j.1365-3016.2000.00297.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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