Pain Relief and Miscarriage and Adverse Pregnancy Outcomes

Could over-the-counter pain relief be a contributing factor in miscarriage and adverse pregnancy outcomes? 

Often there is an assumption that ‘over-the-counter’ medications are safe and therefore can be used in pregnancy. Well, unfortunately, this is not always the case. A 2018 study assessing the risk of miscarriage in women who consumed non-steroidal anti-inflammatory drugs (NSAIDs), found that there was a dose-response relationship between NSAID use around conception and risk of miscarriage. Researchers followed 1097 women’s pregnancies and correlated miscarriage rates with NSAID use. They found that there was a 60% increased risk of miscarriage for women who consume NSAIDS when compared with a) those who consumed no medication and b) those who used acetaminophen (paracetamol). 

The researchers assessed the results for the women after splitting them into 2 groups and found that higher frequency of NSAID use was associated with a greater risk; those who used NSAIDs for ≥15 days had an 85% increased risk compared with those who used NSAIDs for ≤ 14 days where there was a 37% increased risk. The associations were strongest for early miscarriage (<8 weeks gestational age) and for women with low body weight (Li DK, 2018).

There is more to the story here than just avoiding NSAIDs whilst trying to conceive. Once you are pregnant, it is also best to avoid these medications if possible. NSAID use has been associated with adverse outcomes for the baby including an increased risk of premature closure of the fetal ductus arteriosis (fetal blood flow around the heart) and has been associated with adverse outcomes effecting the brain, kidney, lung, skeleton, gastrointestinal tract and cardiovascular system (Antonucci R, 2012).

Based on results from the first study mentioned above, paracetamol appears to be safer for use in pregnancy and around conception, however, it has also been associated with an increase in attention-deficit/hyperactivity disorder in children who were exposed during the third trimester of gestation (Gou X, 2019) so best avoided if possible. 

If you are experiencing pain, inflammation or fever and you are trying to conceive or you are pregnant, it might be worth thinking twice before popping some over-the-counter pain relief. There are many other natural and likely safer ways to manage pain. It is always important to talk to your naturopath or health care professional about your pain management, especially if you are unsure of its safety.