Document Detail


Anti-inflammatory pharmacotherapy during pregnancy.
MedLine Citation:
PMID:  15013926     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
NSAIDs or cyclooxygenase inhibitors (COX inhibitors), including aspirin, are widely used to treat pain, fever and the articular symptoms of chronic rheumatic diseases. Manifestations of connective tissue or autoimmune diseases are commonly treated with glucocorticosteroids. The effect and side effects of NSAIDs depend on the isoforms of cyclooxygenases that they preferentially or selectively inhibit. The use of COX inhibitors has recently been associated with infertility and miscarriage. The classical nonselective COX inhibitors, including aspirin, do not increase the risk of congenital malformations in humans but administered in the latter part of gestation, they can affect pregnancy and the fetus. The ability of nonselective and selective COX inhibitors to prolong gestation has been used by obstetricians to inhibit premature delivery. The vascular effects of prostaglandin inhibitors can cause constriction of the fetal ductus arteriosus and reduce renal blood flow. These complications have been described for most nonselective COX inhibitors but are increasingly reported also for the selective COX-2 inhibitors. Aspirin, which causes irreversible inhibition of cyclooxygenases, differs from other NSAIDs with regard to indication, effects and side effects. Prematurity, which is increased in pregnancies of women with connective tissue diseases, is an additional risk factor for adverse effects of antenatal exposure to NSAIDs. Therefore, treatment with COX inhibitors should be discontinued at week 32 of gestation. The ability of NSAIDs to compromise reproductive function by inhibition of ovulation and as causative agents for miscarriage is still under debate. Glucocorticosteroids given in early pregnancy are a risk factor for the development of oral clefts. Therefore, the daily dose should be kept to <or= 15 mg during the first trimester. High doses of glucocorticosteroids in the second and third trimester are reserved for flares of autoimmune diseases. Intrauterine fetal growth restriction and premature delivery are possible side effects of high doses.
Authors:
Monika E Østensen; Johan F Skomsvoll
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Expert opinion on pharmacotherapy     Volume:  5     ISSN:  1465-6566     ISO Abbreviation:  Expert Opin Pharmacother     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-03-11     Completed Date:  2004-05-21     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  100897346     Medline TA:  Expert Opin Pharmacother     Country:  England    
Other Details:
Languages:  eng     Pagination:  571-80     Citation Subset:  IM    
Affiliation:
Department of Rheumatology, University Hospital of Berne, Berne, Switzerland. monika.ostensen@insel.ch
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MeSH Terms
Descriptor/Qualifier:
Abnormalities, Drug-Induced
Adrenal Cortex Hormones / adverse effects,  therapeutic use
Anti-Inflammatory Agents, Non-Steroidal / adverse effects,  therapeutic use*
Arthritis / drug therapy
Aspirin / adverse effects,  therapeutic use
Clinical Trials as Topic
Cyclooxygenase Inhibitors / adverse effects,  therapeutic use*
Female
Fever / drug therapy
Humans
Maternal-Fetal Exchange
Pain / drug therapy
Pregnancy
Pregnancy Complications / drug therapy*
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Anti-Inflammatory Agents, Non-Steroidal; 0/Cyclooxygenase Inhibitors; 50-78-2/Aspirin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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