Pregnancy and Medications Like Motrin

Motrin and similar medications that belong to the class of Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used medications in pregnancy, with about 1 in 5 women in the United States recalling the use of one of these products early in pregnancy according to the National Birth Defects Prevention Study

Although NSAIDs are typically not to be used late in pregnancy, early pregnancy use has not consistently been associated with increased risks for birth anomalies in the baby, in human studies.
Animal studies have suggested, in particular, that nonselective NSAIDs such as aspirin, ibuprofen, might be associated with increased risks birth defects

Dr. Christina D. Chambers looked at a recent report from the National Birth Defects Prevention Study – an ongoing, large, U.S. multisite study
The study of about 15,000 women from 1997-2004 has suggested that specific NSAIDs might be associated with small to moderate increases in risk for several specific congenital anomalies.
The results of this study suggested that NSAIDs are not a major cause of birth defects.

The defects that occurred more commonly included spinal cord (neural tube) defects, eye defects,mouth( oral clefts), limb reduction defects, amniotic bands/limb body wall defects, and heart defects like pulmonary valve stenosis.

The strengths of this study are the large sample size, including sufficient numbers of specific defects to detect low to moderate risks for certain associations, and large enough numbers to examine risk with exposure to specific NSAID products; maternal interview data regarding actual use of the medications rather than just prescription dispensing; and information on important confounders such as alcohol, tobacco, and folic acid supplement use.

On the other hand, the interview data collection process involved maternal recall up to 24 months after delivery; thus, recollection of mothers – particularly for medications that might be taken sporadically and are available for purchase over the counter – might have been inaccurate. It is also unknown to what extent the underlying conditions in the mother being treated by NSAIDs could have contributed to some of the increased risks that were found in this study.

In addition to these caveats, some or all of the findings in this study could be due to chance, and more studies are needed to follow-up on these concerns.
For clinicians and their patients, it is important to recognize that the suggested increased risks are for relatively rare congenital anomalies.

Thus, even if some of the reported associations are causal, mild to moderate increased risks for these specific defects translate to low absolute risks for the individual patient.
For example, if the risk for cleft lip with or without cleft palate is 1 in 1,000 live births in the general population, this study would suggest that for every 1,000 women who take ibuprofen in the first trimester, an additional 0.6 infants would be born with cleft lip-a mouth defect .

Nevertheless, given the frequency of use of these medications in pregnant women in the first three months of pregnancy, this study suggests that caution might be exercised in situations in which casual or indiscriminate use of these medications in early pregnancy could be avoided.

Dr. Chambers is associate professor of pediatrics and family and preventive medicine at the University of California, San Diego. She is director of the California Teratogen Information Service and Clinical Research Program.

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