Nonsteroidal Anti-Inflammatory Drugs During Pregnancy and the Initiation of Lactation

Bloor, Melanie; Paech, Michael J.

doi:10.1213/ane.0b013e31828a4b54

Cited by 128 publications

(56 citation statements)

References 128 publications

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“…Alternatives to opioids for the treatment of pain, most notably the non-steroidal anti-inflammatory drugs, also have potential safety concerns associated with their use in pregnancy. 22 Thus, there is need for comparative safety and effectiveness research to determine the optimal approach to the treatment of painful conditions in pregnancy. Likewise, it will be important to develop evidence for the safest approach for treating perioperative pain in pregnant women, as up to 2% of pregnant women will undergo non-obstetric surgery.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Opioid Utilization in Pregnancy in a Large Cohort of Commercial Insurance Beneficiaries in the United States

et al. 2014

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Background There are few data regarding the utilization of opioids during pregnancy. The objective of this study was to define the prevalence and patterns of opioid use in a large cohort of pregnant women who were commercial insurance beneficiaries. Methods Data for the study were derived from a de-identified research database of women from across the United States who had both medical and prescription benefits. Using diagnostic codes we defined a cohort of 534,500 women with completed pregnancies who were enrolled in a commercial insurance plan from 6 months prior to pregnancy through delivery. Results Overall, 76,742 (14.4%) women were dispensed an opioid at some point during pregnancy. There were 30,566 (5.7%) women dispensed an opioid during the first trimester, 30,434 (5.7%) women during the second trimester, and 34,906 (6.5%) women during the third trimester. Of these, 11,747 (2.2%) women were dispensed opioids 3 or more times during pregnancy. The most commonly dispensed opioids during pregnancy were hydrocodone (6.8%), codeine (6.1%), and oxycodone (2.0%). The prevalence of exposure at anytime during pregnancy decreased slightly during the study period from 14.9% for pregnancies that delivered in 2005 to 12.9% in 2011. The prevalence of exposure varied significantly by region, and was lowest in the Northeast and highest in the South. Conclusions This study demonstrated that opioids are very common exposures during pregnancy. Given the small and inconsistent body of literature on their safety in pregnancy, these findings suggest a need for research in this area.

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Section: Discussionmentioning

confidence: 99%

Patterns of Opioid Utilization in Pregnancy in a Large Cohort of Commercial Insurance Beneficiaries in the United States

et al. 2014

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“…45,46 The inference that acute inflammation usually has positive effects is strongly supported by the finding that inhibiting the inflammatory response by nonsteroidal antiinflammatory drugs worsens wound and bone healing, [47][48][49][50] increases the risk of anastomotic failure or sepsis after surgery, 51,52 aggravates heart and renal failure, 53,54 interferes with an adequate immune response to antigen presentation in the intestine (leading to ulceration and bleeding), [55][56][57][58] and causes premature birth and cryptorchism in neonates. [58][59][60][61][62]…”

Section: Inflammation and Tissue Growthmentioning

confidence: 99%

Hypoalbuminemia: Pathogenesis and Clinical Significance

Soeters

Wolfe

Shenkin

2018

J Parenter Enteral Nutr

774

554

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Hypoalbuminemia is associated with inflammation. Despite being addressed repeatedly in the literature, there is still confusion regarding its pathogenesis and clinical significance. Inflammation increases capillary permeability and escape of serum albumin, leading to expansion of interstitial space and increasing the distribution volume of albumin. The half‐life of albumin has been shown to shorten, decreasing total albumin mass. These 2 factors lead to hypoalbuminemia despite increased fractional synthesis rates in plasma. Hypoalbuminemia, therefore, results from and reflects the inflammatory state, which interferes with adequate responses to events like surgery or chemotherapy, and is associated with poor quality of life and reduced longevity. Increasing or decreasing serum albumin levels are adequate indicators, respectively, of improvement or deterioration of the clinical state. In the interstitium, albumin acts as the main extracellular scavenger, antioxidative agent, and as supplier of amino acids for cell and matrix synthesis. Albumin infusion has not been shown to diminish fluid requirements, infection rates, and mortality in the intensive care unit, which may imply that there is no body deficit or that the quality of albumin “from the shelf” is unsuitable to play scavenging and antioxidative roles. Management of hypoalbuminaemia should be based on correcting the causes of ongoing inflammation rather than infusion of albumin. After the age of 30 years, muscle mass and function slowly decrease, but this loss is accelerated by comorbidity and associated with decreasing serum albumin levels. Nutrition support cannot fully prevent, but slows down, this chain of events, especially when combined with physical exercise.

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“…NSAIDs are useful in a variety of pain conditions due to their analgesic and anti-inflammatory actions mediated by inhibition of COX enzymes. 64 All NSAIDs easily cross the placenta, and their safety profile in pregnancy depends on the timing, dose, and duration of exposure. Due to the high prevalence of NSAID use in pregnancy, adverse effects from their use could have substantial public health impacts.…”

Section: Safety Of Analgesic Typesmentioning

confidence: 99%

Medication Use and Pain Management in Pregnancy: A Critical Review

Black¹,

Khor

Kennedy

et al. 2019

Pain Practice

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Background Pain during pregnancy is common, and its management is complex. Certain analgesics may increase the risk for adverse fetal and pregnancy outcomes, while poorly managed pain can result in adverse maternal outcomes such as depression and hypertension. Guidelines to assist clinicians in assessing risks and benefits of exposure to analgesics for the mother and unborn infant are lacking, necessitating evidence‐based recommendations for managing pain in pregnancy. Methods A comprehensive literature search was conducted to assess pregnancy safety data for pharmacological and nonpharmacological pain management methods. Relevant clinical trials and observational studies were identified using multiple medical databases, and included studies were evaluated for quality and possible biases. Results Paracetamol and nonsteroidal anti‐inflammatory drugs (NSAIDs) are appropriate for mild to moderate pain, but NSAIDs should be avoided in the third trimester due to established risks. Short courses of weaker opioids are generally safe in pregnancy, although neonatal abstinence syndrome must be monitored following third trimester exposure. Limited safety data for pregabalin and gabapentin indicate that these are unlikely to be major teratogens, and tricyclic antidepressants and serotonin‐norepinephrine reuptake inhibitors have limited but overall reassuring safety data. Many of the included studies were limited by methodological issues. Conclusions Findings from this review can guide clinicians in their decision to prescribe analgesics for pregnant women. Treatment should be tailored to the lowest therapeutic dose and shortest possible duration, and management should involve a discussion of risks and benefits and monitoring for response. Further research is required to better understand the safety profile of various analgesics in pregnancy.

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Nonsteroidal Anti-Inflammatory Drugs During Pregnancy and the Initiation of Lactation

Cited by 128 publications

References 128 publications

Patterns of Opioid Utilization in Pregnancy in a Large Cohort of Commercial Insurance Beneficiaries in the United States

Patterns of Opioid Utilization in Pregnancy in a Large Cohort of Commercial Insurance Beneficiaries in the United States

Hypoalbuminemia: Pathogenesis and Clinical Significance

Medication Use and Pain Management in Pregnancy: A Critical Review

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