Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: population based cohort study
Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: population based cohort study
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DOI：
10.1136/bmj.327.7411.368
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发表时间：
2003-08-16
影响因子：
--
通讯作者：
Douh, R
中科院分区：
文献类型：
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作者：
Li, DK;Liu, LY;Douh, R
目的探讨产前使用非甾体类抗炎药（NSAIDs）是否与流产风险增加有关。设计基于人群的队列研究。产前使用非甾体抗炎药、阿司匹林和扑热息痛（对乙酰氨基酚）通过面谈确定。在美国旧金山地区设立Kaiser Permanente医疗保健计划，这是一个医疗保健提供系统。参与者招募了1055名孕妇，并在怀孕测试呈阳性后立即接受了采访。入组时的中位胎龄为40天。主要结局指标妊娠结局至妊娠20周。结果53名妇女（5%）报告在怀孕前后或怀孕期间使用非甾体抗炎药。在对潜在混杂因素进行校正后，产前使用非甾体抗炎药与流产风险增加80%相关（校正风险比为1.8(95%可信区间为1.0 - 3.2)）。如果最初使用非甾体抗炎药是在怀孕前后，或者使用非甾体抗炎药持续超过一周，这种关联会更强。产前服用阿司匹林同样与流产风险增加有关。然而，产前使用扑热息痛（药理学上不同于非甾体抗炎药和阿司匹林）与流产风险增加无关，与使用时间和持续时间无关。结论产前使用非甾体抗炎药和阿司匹林会增加流产的风险。这些发现需要在专门设计的研究中得到证实，以检验这种明显的联系。
Objective To evaluate whether prenatal use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with increased risk of miscarriage.Design Population based cohort study. Prenatal use of NSAIDs, aspirin, and paracetamol (acetaminophen) ascertained by in-person interview.Setting Kaiser Permanente Medical Care Program, a healthcare delivery system, in the San Francisco area of the United States.Participants 1055 pregnant women recruited and interviewed immediately after their positive pregnancy test. Median gestational age at entry to the study was 40 days.Main outcome measures Pregnancy outcomes up to 20 weeks of gestation.Results 53 women (5%) reported prenatal NSAID use around conception or during pregnancy. After adjustment for potential confounders, prenatal NSAID use was associated with an 80% increased risk of miscarriage (adjusted hazard ratio 1.8 (95% confidence interval 1.0 to 3.2)). The association was stronger if the initial NSAID use was around the time of conception or if NSAID use lasted more than a week. Prenatal aspirin use was similarly associated with an increased risk of miscarriage. However, prenatal use of paracetamol, pharmacologically different from NSAIDs and aspirin, was not associated with increased risk of miscarriage regardless of timing and duration of use.Conclusion Prenatal use of NSAIDs and aspirin increased the risk of miscarriage. These findings need confirmation in studies designed specifically to examine the apparent association.