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Why Are NSAIDs Not Recommended During Pregnancy?

Pregnant woman reading nsaids instructions.

NSAIDs (non-steroidal anti-inflammatory drugs) are drugs that can cause miscarriages and fetal kidney damage, among other maladies. The US Food and Drug Administration (FDA) has issued a warning about the use of NSAIDs by pregnant women. Nevertheless, under certain circumstances, the use of NSAIDs in pregnancy is entirely appropriate.

What Are NSAIDs?

NSAIDs are a class of drugs available over-the-counter (OTC) and by prescription.

  • NSAIDs are most commonly used to treat menstrual cramps, headaches, colds, and the flu;
  • NSAIDs work by inhibiting the body’s inflammation response; and
  • NSAIDs frequently cause side effects such as constipation, abdominal pain, diarrhea, flatulence, heartburn, dizziness, nausea, and vomiting.

Doctors and patients commonly use NSAIDs for pain and fever. Examples of NSAIDs include aspirin, ibuprofen, naproxen, diclofenac, and celecoxib (but not Tylenol). Many pregnant women use these medications in response to disorders that are caused by pregnancy. Multi-symptom cold remedies commonly contain NSAIDs as well.

Since many OTC medicines contain NSAIDs, read the Drug Facts labels carefully to determine if they contain NSAIDs.

NSAID Risks in Early Pregnancy: Miscarriage

All pregnant women face the risk of miscarriage. This risk is particularly acute, however, among women who used NSAIDs during early pregnancy. Research conducted by Kaiser Permanente found that women who used NSAIDs in early pregnancy quadrupled their risk of miscarriage.

NSAIDs reduce inflammation, and this response interferes with the production of prostaglandin. Prostaglandin is a hormone that is critical for implanting an embryo in the uterus. An expectant mother can easily cause a miscarriage through NSAIDs before she even realizes she is pregnant. Research indicates that NSAIDs around conception and during the first 30 weeks of pregnancy substantially increase the risk of a miscarriage.

NSAID Risks in Later Pregnancy: Stunted Fetal Kidney Development and Low Amniotic Fluid

The FDA concluded that NSAIDs from around the 20th week of pregnancy could cause kidney problems in the baby. Since the baby’s kidney produces amniotic fluid and sufficient amniotic fluid levels are critical for fetal development, kidney problems in the baby can put any pregnancy at risk. Low amniotic fluid can damage a baby’s lungs, digestive system, and muscles.

Ibuprofen-Related Birth Defects

Ibuprofen can cause specific congenital disabilities in one out of several thousand births. Relatively common ibuprofen-related congenital disabilities include the following:

  • Amniotic band syndrome: This defect occurs when the amniotic sac tears and entangles parts of your baby’s body. It can be severe or relatively mild, depending on which parts of your baby’s body were entangled. Ibuprofen triples the risk of this condition.
  • Anophthalmia: This birth defect occurs when a child is born without one or both eyes.
  • Cleft lip and cleft palate: A fissure in the palate that causes a clefting of the lip or on the roof of the mouth.
  • Microphthalmia: Babies born with this birth defect have smaller eyes and suffer serious vision deficiencies.
  • Neural tube defects: A neural tube defect is a severe deformity of a child’s central nervous system.
  • Pulmonary valve stenosis: Pulmonary valve stenosis occurs when the aorta narrows to the extent that the heart has trouble pumping blood throughout the body.
  • Transverse limb deficiencies: Transverse limb deficiencies is a medical term for club feet and club hands.

The use of NSAIDs other than ibuprofen also carries the risk of increasing the likelihood of birth defects.

When Should You Use NSAIDs?

The use of medication is almost always a balancing act between risks and benefits. In a few cases, the balance tips in favor of limiting the use of NSAIDs in pregnancy, at least until the 30-week mark. Low doses of aspirin, for example, can help treat preeclampsia and prevent premature birth. Even under these circumstances, you should minimize your use of NSAIDs to the lowest effective dose. Your doctor should also monitor your amniotic fluid levels.

Putting It into Perspective: Your Risk

The human body could be described as a big bag of genes and chemicals. Every one of us is unique, and it is impossible to predict precisely how a given medication will affect us. This uncertainty is particularly intractable for a patient taking multiple medications that might interact with one another. Even a medical professional can only calculate the odds and issue a recommendation based on the magnitude of the potential harm multiplied by its likelihood.

All drugs, even over-the-counter medications, have side effects, and the use of any medication carries the risk of causing an unpleasant or harmful side effect. This is true even if your doctor prescribes it to you and you use it exactly as instructed. Ultimately, no one can say with certainty how your body will react to the use of NSAIDs in pregnancy. Your best bet, then, is to play it safe and hope for the best.

Recommendations for Doctors

Doctors should limit their prescription of NSAIDs before the 30th week of pregnancy, and they should limit the dosage to the smallest effective dose. After the 30th week of pregnancy, doctors should not prescribe NSAIDs at all. Finally, doctors should warn their patients about the use of NSAID-based OTC preparations.

Alternative Medications

If you are pregnant, talk with your doctor about using the following alternative treatments for common disorders.

  • For headaches, use acetaminophens such as Tylenol rather than ibuprofen or aspirin. One of the advantages of acetaminophen is that it targets pain directly rather than targeting inflammation. You could also consider meditation and light exercise.
  • If you come down with a cold or the flu, stay in bed and drink plenty of water. Don’t use a multi-symptom cold remedy because these often include NSAIDs. Instead, use single-symptom medications, such as dextromethorphan, for a cough.
  • If you suffer pregnancy-related lower back pain, talk with your doctor about physical therapy.

Always check the label of any OTC medicine you buy to make sure no NSAIDs are present.

NSAIDs and Medical Malpractice

In an NSAID-related claim, a doctor might generate a claim of medical malpractice by:

  • Inappropriately prescribing NSAIDs to a pregnant patient (after the 30th week of pregnancy, for example);
  • Failing to monitor amniotic fluid levels in a pregnant patient, even though NSAIDs are being used after the 20th week of pregnancy; or
  • failing to warn a pregnant patient of the dangers of over-the-counter NSAIDs and how to minimize these dangers.

Other NSAID-related acts or omissions by your healthcare provider could also lay the groundwork for an NSAID-based medical malpractice claim.

Building a Medical Malpractice Claim: The Standard of Proof

Medical malpractice occurs when a doctor causes harm by treating a patient in a manner that falls beneath a professional standard of care. You must prove four elements to win:

  • A doctor-patient relationship existed between you and your healthcare provider;
  • Your healthcare provider’s medical treatment fell below the applicable standard of care expected of a professional (in other words, it constituted professional negligence);
  • The plaintiff (you or the baby) suffered harm; and
  • The professional negligence caused the injury at issue.

You must prove each one of these elements was present by a “preponderance of the evidence.” A preponderance of the evidence is anything over a 50% likelihood.

Establishing Professional Negligence

In a medical malpractice lawsuit, an expert witness will testify on the standard of care that applies under your claim’s particular circumstances. Both sides might call expert witnesses, each of whom may contradict the other’s testimony. It will then be up to the jury to decide which side’s expert witness testimony is the most credible.

Causation

You wouldn’t be entitled to any compensation unless your healthcare provider’s negligence caused the injury in your complaint. If you gave birth to a baby suffering from a birth defect that is not statistically correlated to the use of NSAIDs, for example, even if your doctor prescribed you NSAIDs during pregnancy, you probably won’t be able to prove causation. Causation can be a tricky element to establish in an NSAID case.

Can You Sue for Wrongful Death Based on a Miscarriage?

Nationwide, the case law is murky on the question of whether you can sue a doctor for wrongful death in the event of a miscarriage. However, in Connecticut, the consensus seems to be that a baby must be born alive for a wrongful death claim to arise. Nevertheless, it is still possible to sue a healthcare provider for medical malpractice over a miscarriage caused by professional negligence.

We Settle Most of Our Claims out of Court

The vast majority of our clients’ claims never make it to trial because defendants prefer to negotiate a solution rather than litigate in court. Even when we file a lawsuit, in most cases, no trial takes place. Nevertheless, the best way to win a claim at the negotiating table is to prepare to win it in court.

We’re Waiting for You to Contact Us

The experienced Connecticut personal injury lawyers at Berkowitz Hanna have been fighting and winning birth injury claims for many years now. We are fully capable of investigating your case, building a legal claim, and winning it. Our trial record strikes fear into opposing parties’ hearts because we have won many multi-million dollar verdicts.

If you or your child has suffered a birth-related injury, especially one that may have been related to the use of NSAIDs during pregnancy, call Berkowitz Hanna today or contact us online for a free initial consultation. We serve clients throughout Connecticut from our offices in Stamford, Bridgeport, Danbury, and Shelton. Don’t forget—you owe us nothing unless you win your claim.