Population developmental hazard of over-the-counter NSAIDs

Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs, i.e., aspirin, diclofenac, dipyrone, ibuprofen, naproxen) and paracetamol are commonly ingested medications during pregnancy that for a long time were classified as relatively safe for mothers and fetuses.

The review focuses on developmental toxicity of OTC NSAIDs.

Same epidemiological studies show that OTC antipyretics and painkillers may increase risk of spontaneous abortion, intrauterine growth retardation, preterm constriction of ductus arteriosus with secondary persistent pulmonary hypertension, reduced fetal renal perfusion that leads to oligohydramion, prolonged pregnancy, as well as selected congenital anomalies, including orofacial cleft, cardiovascular (i.e. ventricular septal defect, pulmonary valve stenosis) and neural tube defects (i.e., anophthalmia/microphthalmia, encephalocele, spina bifida), amniotic bands/limb body wall defects, and transverse limb deficiencies. However, other reports prove high prenatal tolerability or even beneficial effect in case of selected maternal sicknesses, especially influenza or disease with fever and thrombotic complications. The best advice for pregnant women is to avoid any xenobiotic, especially multidrug therapy, but in case OTC NSAIDs are needed they should be ingested in lowest effective dose under physician consultation. After gestational week 20, NSAIDs could be ingested with caution and withdrawn at gestational week 32, since they may induce constriction of the ductus arteriosus and affect renal function. The only exception is low-dose of aspirin, ingestion of which should be stopped one week before delivery with epidural anesthesia or could be prolonged until the end of pregnancy in patients with antiphospholipid syndrome.