Use of Nonsteroidal Anti-Inflammatory Drugs in Pregnant Women with Inflammatory Arthritis

Neda Amiri¹, Gretchen Bandoli², Diana L Johnson² and Christina D. Chambers², ¹Division of Rheumatology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada, ²Pediatrics, University of California, San Diego, La Jolla, CA

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Ankylosing spondylitis (AS), Nonsteroidal antiinflammatory drugs (NSAIDs), pregnancy, psoriatic arthritis and rheumatoid arthritis (RA)

Session Information

Date: Tuesday, November 15, 2016

Title: Reproductive Issues in Rheumatic Disorders - Poster

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Use of Nonsteroidal Anti-inflammatory Drugs in Pregnant Women with Inflammatory Arthritis

Background/Purpose: Nonsteroidal anti-inflammatory drugs (NSAIDs) are generally contraindicated in the third trimester of pregnancy due to concerns for potential maternal or fetal complications. However, data are limited on NSAID use in pregnant women with inflammatory arthritis. The objective of our study was to describe the prevalence of NSAID use in pregnant women in this population and to explore associations between NSAIDs and selected adverse fetal or pregnancy outcomes

Methods: The sample was selected from the Organization of Teratology Information Specialists (OTIS) Autoimmune Diseases in Pregnancy project, a North American prospective cohort study of pregnant women. Women with singleton, live births (enrolled 2005-2015) who had rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis were selected. NSAID exposure was captured through interviews; outcomes were obtained from interviews and medical records. ÒExposedÓ women were defined as those with any NSAID use in pregnancy. Women who reported no NSAID use were classified as ÒunexposedÓ. The primary outcome was prevalence of NSAID use in pregnancy. We also examined the incidence of premature closure of ductus arteriosus, patent ductus arteriosus, persistent pulmonary hypertension, intracranial hemorrhage, small for gestational age infants, preterm birth and postpartum hemorrhage in the exposed compared to the unexposed.

Results: A total of 855 pregnant women with inflammatory arthritis were included, of which 294 (34%) reported NSAID use at some time during pregnancy. The most commonly utilized NSAIDs were ibuprofen (39%), aspirin (30%), naproxen (17%), and celecoxib (14%). The prevalence of use was highest in the first trimester (88%), and decreased thereafter (46% second trimester, 31% third trimester). Among those who reported NSAID use in the third trimester (n=92), the mean cumulative days of use was 53.89±30.90 days, with average gestational age at cessation of use being 38.09±1.95 weeks. There was no evidence of an increased risk for any of the outcomes studied except for maternal hypertension associated with 3^rd trimester NSAID use (aRR 2.13, 95% CI 1.18,3.59) (Tables 1 and 2).

Conclusion: NSAID use in this cohort was common with almost one third of the women using this class of medication in the third trimester. Although the sample size was limited, we did not find evidence of increased risk for most of the evaluated outcomes. Additional studies are needed to determine whether NSAID use in the third trimester is associated with increased risk of gestational hypertension/pre-eclampsia.

Table 1. Fetal and Maternal Outcomes among NSAID Exposed and Unexposed
		Anytime during Pregnancy		3^rd Trimester Use
	NSAID Unexposed (n=561)	NSAID Exposed (n = 294)	RR	NSAID Exposed (n=94)	RR
Patent ductus arteriosus	5	3	1.14 (0.24,4.63)	2	2.44 (0.35,11.14)
Intracranial hemorrhage	1	3	5.72 (0.74,1.15)	1	6.10 (0.24,155.33)
Postpartum hemorrhage	31	14	0.85 (0.44,1.53)	6	1.15 (0.44,2.48)
Small for gestational age	48	33	1.31 (0.86,1.99)	7	0.88 (0.37,1.75)
Preterm Birth	71	43	1.16 (0.81,1.63)	16	1.37 (0.80,2.18)
Gestational hypertension / Preeclampsia	48	36	1.41 (0.93,2.12)	18	2.24 (1.32,3.59)

Table 2. Adjusted Models for Fetal and Maternal Outcomes among NSAID Exposed and Unexposed
	Anytime during Pregnancy	3^rd Trimester Use
	aRR	aRR
Small for gestational age	1.17 (0.72,1.86)	0.90 (0.35,1.89)¹
Preterm Birth	1.02 (0.70,1.47)	1.32 (0.76,2.14)
Gestational hypertension / Preeclampsia	1.36 (0.86,2.12)²	2.13 (1.18,3.59)²
Models adjusted for disease activity, SES, and gestational age at enrollment unless otherwise specified. ¹Only adjusted for disease activity. ²Adjusted for disease activity, SES, pre-pregnancy BMI, gestational age at enrollment

Disclosure: N. Amiri, None; G. Bandoli, None; D. L. Johnson, None; C. D. Chambers, Contract Apotex, Inc., Barr Labs, Inc., 2,Contract Bristol Myers/Squibb, 2,University of British Columbia, 2,Contract Genzyme (Sanofi-Aventis), 2,Contract UCB Pharma, 2,Contract Janssen Biotech, Inc., 2,Contract Pfizer, 2,Contract AAAAI VAMPSS Post marketing Surveillance of Afluria, 2,Contract Celgene, 2,Contract Takeda, 2,Birth Defects Research Part A: Clinical and Molecular Teratology, 3.

To cite this abstract in AMA style:

Amiri N, Bandoli G, Johnson DL, Chambers CD. Use of Nonsteroidal Anti-Inflammatory Drugs in Pregnant Women with Inflammatory Arthritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/use-of-nonsteroidal-anti-inflammatory-drugs-in-pregnant-women-with-inflammatory-arthritis/. Accessed .

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