NSAIDs, including commonly used neck pain medications, have been associated with a small to moderate increase in the risk of a number of birth defects according to new research published in the American Journal of Obstetrics and Gynecology. The scientists found that prenatal use of non-steroidal anti-inflammatory medications did not cause a major increase in risk but were connected with a small increase in the incidence of oral clefts, neural tube defects, anopthalmia, and a number of other abnormalities. Those taking medications for chronic pain may wish to revise usafe of these drugs prior to conception in order to ameliorate risk.
NSAIDs and Birth Defects
The researchers at the Center for Birth Defects Research and Prevention at the Massachusetts Department of Public Health in Boston found that problematic pain-relievers included ibuprofen, aspirin, and naproxen, which many sufferers of chronic neck pain use daily to help manage symptoms. The types of birth defects seen with the use of such drugs included oral clefts, neural tube defects, anopthalmia, micropthalmia, transverse limb deficiencies, amniotic band syndrome, limb body wall deficiencies, and pulmonary valve stenosis. The team of researchers looked at 3173 women who were prescribed NSAIDs, as well as 1452 who used them as needed and assessed the risk of twenty-nine separate birth defect groups. Most of these were not associated with an increased risk following NSAID use but nine types of birth defect did have an increased associated risk.
The multisite study, which is case-controlled, looked at a number of risk factors, including NSAID use and is funded by the Centers for Disease Control and Prevention (CDC). For some birth defects the adjusted odds ratio was 2 or 3, although most fell between 1 and 2 for aspirin, ibuprofen, and naproxen. The highest increased risk was for anopthalmia or micropthalmia with aspirin use (AOR of 3 with a range of 1.3-7.3). These conditions are birth defects affecting the eyes, either the absence of one or both eyes (anopthalmia), or a condition where one or both eyes are much smaller than normal (micropthalmia). Other birth defects with a higher risk associated with aspirin use included anencephaly or craniorachiasis (AOR 2.0), encephalocele (2.1), and amniotic bands (2.5) amongst other conditions. Ibuprofen was associated with risks for anopthalmia (1.9), amniotic bands and limb body wall defects (2.2), as well as other conditions. Naproxen use had an associated increase in risk for encephalocele (2.5), anopthalmia or micropthalmia (2.8), transverse limb deficiency (2.0), and isolated pulmonary valve stenosis (2.4), as well as five other birth defects.
Following on from this research it is likely that studies looking at the timing, frequency, dose, and indications for use of NSAIDs during pregnancy will be the subject of further investigation. Such research does not mean that those requiring NSAIDs in pregnancy should simply discontinue use as the stress of pain, and the potential ramifications of uncontrolled inflammation can also be damaging. The small to moderate risk increase should instead be weighed against the benefits of using ibuprofen, naproxen, or aspirin for chronic pain management. Opioid drugs used just prior to conception or during early pregnancy were also associated with an increase in birth defects (including hypostatic left heart syndrome) in another study, so the options for those in pain are limited.
NSAID Use in Pregnancy
Unfortunately, pregnancy itself can lead to neck pain as inflammation is more common, water retention can cause stenosis, and increased stress along with poor sleep patterns may all increase sensitivity to pain. NSAIDs are often the first thing patients think of when dealing with neck pain, with nearly 23% of the women included in this survey making use of NSAIDs in their first trimester. Such research does suggest that limiting their use is a sensible approach and women may wish to explore alternative neck pain treatments, such as acupuncture, relaxation techniques, massage, and even herbal anti-inflammatories. Of course, doctors’ advice should be sought prior to beginning any such treatment, and doctors themselves are reminded to assess the potential teratogenic effects or reproductive effects of prescribed medications when consulting with women who are planning a pregnancy or are already pregnant. As an estimated 50% of pregnancies are unplanned in the US it is, however, insufficient to start discussing the risks after the fact, and women, and their partners, may see this latest research as a reminder to apply caution before using the NSAIDs associated with birth defects in this latest study.
Hernandez RK, Werler MM, Romitti P, Sun L, Anderka M; National Birth Defects Prevention Study. Nonsteroidal antiinflammatory drug use among women and the risk of birth defects. Am J Obstet Gynecol. 2012 Mar;206(3):228.e1-8. Epub 2011 Dec 1.