Over-the-counter Analgesics in Pregnancy and Offspring Neonatal Outcomes: A Retrospective Cohort Study

Abstract

Objective To identify associations between in utero exposure to 5 over-the-counter (OTC) analgesics and adverse neonatal outcomes. Design Retrospective cohort study Setting Aberdeen UK Population 151,141 singleton deliveries, 1985 to 2015 Methods Self-reported, non-prescription, consumption of paracetamol, aspirin, ibuprofen, diclofenac and naproxen during pregnancy and neonatal outcomes were obtained from the Aberdeen Maternity and Neonatal Databank (AMND). Univariable and multivariable regression analyses were performed to investigate associations between analgesic use and offspring neonatal outcomes. Crude (cORs) and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported, indicating the strength of association. Main Outcome Measures Premature delivery (<37 weeks), stillbirth, neonatal death, birthweight, standardised birthweight score, neonatal unit admission, APGAR score at 1 and 5 minutes, cryptorchidism, neural tube and amniotic band defects, hypospadias and gastroschisis. Results Pregnancies exposed to at least one of the 5 analgesics were significantly independently associated with increased odds for premature delivery <37 weeks (aOR=1.50, 95%CI 1.43-1.58), stillbirth (aOR=1.33, 95%CI 1.15-1.54), neonatal death (aOR=1.56, 95%CI 1.27-1.93), birthweight <2500g (aOR=1.28, 95%CI 1.20-1.37), birthweight >4000g (aOR=1.09, 95%CI 1.05-1.13), admission to neonatal unit (aOR=1.57, 95%CI 1.51-1.64), APGAR score <7 at 1 minute (aOR=1.18, 95%CI 1.13-1.23) and 5 minutes (aOR=1.48, 95%CI 1.35-1.62), neural tube defects (aOR=1.64, 95%CI 1.08-2.47) and hypospadias (aOR=1.27, 95%CI 1.05-1.54 males only). Conclusions There was a high prevalence of OTC analgesics use during pregnancy, which steeply increased during the 30-year study period. Analgesic consumption was independently associated with multiple adverse neonatal offspring outcomes. The use of paracetamol in combination with other NSAIDs conferred the highest risk.

An analysis of the relationship between analgesic use during pregnancy and stillbirth

“…42 OTC medications are cheap, provide accentuated symptomatic relief which makes a pregnant woman to rely on OTC, thus promoting self-medication without being aware of risk. This had promoted pregnant women to go beyond OTC range that includes 'Schedule H' drugs being dispensed irrationally which are categorised under prescription drugs [47,48] . The majority of antibiotics belong within the schedule H group of medications that are arbitrarily prescribed and used during pregnancy which could attack the mother's host cells, endangering her health and forcing her to ingest more and more drugs, perhaps leading to stillbirth.…”