Effects of non-steroidal anti-inflammatory drugs on the prevalence of fetal structural malformations

Authors

DOI:

https://doi.org/10.33448/rsd-v9i8.5671

Keywords:

Pregnancy; Anti-inflammatory drugs; Fetal development; Risk factors; Malformations.

Abstract

Objective: To evaluate the use of non-steroidal anti-inflammatory drugs (NSAIDs) in the prevalence of structural congenital malformations (CM). Methods: Case-control study carried out in a public hospital that is a reference in fetal medicine. A questionnaire was applied to assess sociodemographic and obstetric factors. The evaluation of fetal morphology was performed through ultrasound evaluation. Results: Of the 282 pregnant women evaluated, 28.72% (81/282) reported use of anti-inflammatory drugs during pregnancy, 75.1% (n = 60) of the case group and 25.9% (n = 21) of the group. group control. Among the anti-inflammatory drugs, the most used were nimesulide (17.38%; n = 49), diclofenac (10.99%; n = 31) and ibuprofen (3.19%; n = 9). The use of NSAIDs in general and specific (nimesulide, diclofenac, ibuprofen) did not differ between groups. However, the highest use of ibuprofen was observed in the case group (4.46%; n = 9) vs control (0%; n = 0) with OR = 7.904, p = 0.05. The use of NSAIDs was higher in pregnant women who had fetuses with CM on the face (55.6%), abdominal wall (38.10%) and central nervous system (CNS) (30.30%). Conclusion: Although there were no differences between groups, the use of NSAIDs was considerable in patients who had a fetus with fetal malformations of the face, abdominal wall and CNS. Due to the high frequency of some malformations, especially those of the face, care should be taken with the indication and especially with the self-medication of this medication class during pregnancy.

References

Andrade, S. M., Cunha, M. A., Holanda, E. C., Coutinho, G. S. L., Verde, R. M. C. L., & Oliveira, E. H. (2020). Caracterização do perfil das intoxicações medicamentosas por automedicação no Brasil, durante o período de 2010 a 2017. Research, Society and Development, 9(7), e236973952. doi: 10.33448/rsd-v9i7.3952

Antonucci, R., Zaffanello, M., Puxeddu, E., Porcella, A., Cuzzolin, L., Pilloni, M. D, & Fanus, D. (2012). Use of Non-steroidal Anti-inflammatory Drugs in Pregnancy: Impact on the Fetus and Newborn. Curr Drug Metab, 13(4), 474–90. doi: 10.2174 / 138920012800166607

Botto, L. D., Lin, A. E., Riehle-Colarusso, T., Malik, S., & Correa, A. (2007). Seeking causes: Classifying and evaluating congenital heart defects in etiologic studies. Birth defects Res A Clin Mol Teratol, 79(10), 714–727. doi: 10.1002 / bdra.20403

Brasil (2017). Ministério da Saúde. Relação Nacional de Medicamentos Essenciais: RENAME. 2017. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/ relacao_nacional_medicamentos_rename_2017.pdf. Acesso em 20 de abril de 2020.

Cleves, M. A., Savell, V. H., Raj, S., Zhao, W., Correa, A., Werler, M. M., Hobbs, C. A., & N. N. D. P. S. (2004). Maternal Use of Acetaminophen and Nonsteroidal Anti-inflammatory Drugs (NSAIDs), and Muscular Ventricular Septal Defects. Birth defects Res A Clin Mol Teratol, 70(3), 107–113. doi: 10.1002 / bdra.20005

Damase-Michel, C., & Hurault-Delarue, C. (2014). Ibuprofen does not seem to increase global malformation risk but NSAID use in late pregnancy remains a concern. Evid Based Med, 19(2), 74. doi: 10.1136 / eb-2013-101495

Dathe, K., Fietz, A. K., Pritchard, L. W., Padberg, S., Hultzsch, S., Meixner, K., Meister, R., & Schaefer, C. (2018). No evidence of adverse pregnancy outcome after exposure to ibuprofen in the first trimester – Evaluation of the national Embryotox cohort. Reprod Toxicol, 79, 32–38. doi: 10.1016 / j.reprotox.2018.05.003

De Santis, M., Straface, G., Carducci, B., Cavaliere, A. F., De Santis, L., Lucchese, A., Merola, A. M., & Caruso, A. (2004). Risk of drug-induced congenital defects. Eur J Obstet Gynecol Reprod Biol, 117(1), 10–19. doi: 10.1016 / j.ejogrb.2004.04.022

Ericson, A., & Källén, B. A. J. (2001). Nonsteroidal anti-inflammatory drugs in early pregnancy. Reprod Toxicol, 15(4), 371–375. doi: 10.1016/S0890-6238(01)00137-X

Fantin, C., Santos, M. L., Carvalho, L. B., Gomes, N. M., Souza, L. N., & Sousa, G. B. (2017). Estudo das anomalias cromossômicas ocorridas em uma maternidade nos anos de 2010 a 2014. Cogitare Enferm, 22 (1), 01-08. doi: 10.5380/ce.v22i1.48599

França, E. B., Lansky, S., Rego, M. A. S., Malta, D. C., França, J. S., Teixeira, R., Porto, D., Almeida, M. F., Souza, M. F. M., Szwarcwald, C. L., Mooney, M., Naghavi, M. & Vasconcelos, A. M. N. (2017). Leading causes of child mortality in Brazil, in 1990 and 2015: Estimates from the Global Burden of Disease study. Rev Bras Epidemiol, 20, 46–60. doi: /10.1590/1980-5497201700050005

Hernandez, R. K., Werler, M. M., Romitti, P., Sun, L, & Anderka, M., E. N. P. D. N. (2017). Nonsteroidal antiinflammatory drug use among women and the risk of birth defects. Am J Obs Gynecol, 25(5), 1032–57. doi: 10.1016 / j.ajog.2011.11.019

Hurtado-Gonzalez, P., Anderson, R. A., Macdonald, J., Van den Driesche, S., Kilcoyne, K., Jørgensen, A., McKinnell, C., Macpherson, S., Sharpe, R., & Mitchell, R. T. (2018). Effects of exposure to Acetaminophen and Ibuprofen on fetal germ cell development in both sexes in rodent and human using multiple experimental systems. Environ Health Perspect, 126(4), 1–17. doi: 10.1289 / EHP2307

Interrante, J. D., Ailes, E. C., Lind, J. N., Anderka, M., Feldkamp, M. L., Werler, M. M., Taylor, L. G., Trinidad, J., Gilboa, S. M., & B. C. N. B. D. P. S. (2017). Risk comparison for prenatal use of analgesics and selected birth defects, National Birth Defects Prevention Study. Physiol Behav, 176(5), 139–148. doi: 10.1016 / j.annepidem.2017.09.003

Källén, B. A. J., & Olausson, P. O. (2003). Maternal drug use in early pregnancy and infant cardiovascular defect. Reprod Toxicol, 17(3), 255–261. doi: 10.1016 / s0890-6238 (03) 00012-1

Leverrier-Penna, S., Mitchell, R. T., Becker, E., Lecante, L., Ben Maamar, M., Homer, N., Lavoué, V., Kristensen, D. M., Dejucq-Rainsford, N., Jégou, B., & Mazaud-Guittot, S. (2018). The Ibuprofen is deleterious for the development of first trimester human fetal ovary ex vivo. Hum Reprod, 33(3), 482–493. doi: 10.1093/humrep/dex383

Markovic, M., Swanson, S. A., Stricker, B. H., Jaddoe, V. W. V., Verhulst, F. C., Tiemeier H, & Marroun, H. E. (2019). Prenatal exposure to non-steroidal anti-inflammatory drugs (NSAIDs) and neurodevelopmental outcomes in children. Pharmacoepidemiol Drug Saf, 28(4), 452–459. doi: 10.1002 / pds.4625

Mitchell, A. A., Gilboa, S. M., Werler, M. M., Kelley, K. E., Louik, C., & Hernández-Díaz, S. (2011). Medication use during pregnancy, with particular focus on prescription drugs: 1976–2008. Am J Obstet Gynecol, 205(1), 51.e1-51.e8. doi: 10.1016/j.ajog.2011.02.029

Nezvalová-Henriksena, K., Spigsetb, O., & Nordeng, H. (2013). Effects of ibuprofen, diclofenac, naproxen, and piroxicam on the course of pregnancy and pregnancy outcome: a prospective cohort study. BJOG, 120(8), 948–959. doi: 10.1111/1471-0528.12192

Nielsen, G. L., Sørensen, H. T., Larsen, H., & Pedersen, L. (2001). Risk of adverse birth outcome and miscarriage in pregnant users of non-steroidal anti-inflammatory drugs: Population based observational study and case-control study. Br Med J, 322(7281), 266–70. doi: 10.1136 / bmj.322.7281.266

Ofori, B., Oraichi, D., Blais, L., & Rey, E. B. A. (2006). Risk of Congenital Anomalies in Pregnant Users of Non-Steroidal Anti-Inflammatory Drugs: A Nested Case-Control Study. Birth Defects Res B Dev Reprod Toxicol, 77, 228–279. doi: 10.1002 / bdrb.20085

Romani, F., Tropea, A., Scarinci, E., Federico, A., Dello Russo, C., Lisi, L., Catino, S., Lanzone, A., & Apa, R. (2014). Endocrine disrupters and human reproductive failure: the in vitro effect of phthalates on human luteal cells. Fertil Steril, 102(3), 831-837. doi: 10.1016 / j.fertnstert.2014.05.041

Rosenberg, L. E., & Rosenberg, D. D. Chapter 15 – Birth Defects. Hum Genes Genomes, 2012, 241–58.

Taye, M., Afework, M., Fantaye, W., Diro, E., & Worku, A. (2016). Magnitude of birth defects in central and northwest Ethiopia from 2010-2014: A descriptive retrospective study. PLoS One, 11(10), 1–12. doi: 10.1371/journal.pone.0161998

Van Gelder, M. M. H. J., Roeleveld, N., & Nordeng, H. (2011). Exposure to non-steroidal anti-inflammatory drugs during pregnancy and the risk of selected birth defects: A prospective cohort study. PLoS One, 6(7), e22174. doi: 10.1371 / journal.pone.0022174

Wang, H., Naghavi, M., Allen, C., Barber, R. M., Carter, A., Casey, D. C., et al. (2016). Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet, 388 (10053), 1459–544. doi: 10.1016/S0140-6736(16)31012-1

Werler, M. M., Mitchell, A. A., Hernandez-Diaz, S., & Honein, M. A. (2005). Use of over-the-counter medications during pregnancy. Am J Obstet Gynecol, 193(3), 771–7. doi: 10.1016 / j.ajog.2005.02.100

World Health Organization (WHO). Congenital anomalies. (2016). Disponível em https://www.who.int/news-room/fact-sheets/detail/congenital-anomalies. Acesso em 04 de junho de 2020.

Published

30/06/2020

How to Cite

TACON, F. S. de A.; MELO, N. C. e; MORAES, C. L. de; CASTRO, M. H. M. de; AMARAL, W. N. do. Effects of non-steroidal anti-inflammatory drugs on the prevalence of fetal structural malformations. Research, Society and Development, [S. l.], v. 9, n. 8, p. e213985671, 2020. DOI: 10.33448/rsd-v9i8.5671. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/5671. Acesso em: 22 nov. 2024.

Issue

Section

Health Sciences