title: Major malformations following exposure to nonsteroidal antiinflammatory drugs during the first trimester of pregnancy.
abstract: OBJECTIVE
  Nonsteroidal antiinflammatory drugs (NSAID) are among the most common medicines used by pregnant women. Published data are controversial regarding fetal safety following intrauterine exposure to NSAID. We investigated exposure to NSAID in the first trimester in a large cohort of infants and fetuses.
  
  
  METHODS
  A computerized database of medications dispensed from 1998 to 2009 to all women registered in the "Clalit" health maintenance organization in Southern Israel was linked with 2 computerized databases containing maternal and infant hospitalization records. Pregnancy terminations for medical reasons were analyzed. The following confounders were controlled for: parity, maternal age, ethnicity, maternal pregestational diabetes, maternal inflammatory disease, and year of birth or pregnancy termination. First trimester exposure to nonselective cyclooxygenase (COX) inhibitors and to selective COX-2 inhibitors as groups and to individual drugs was analyzed.
  
  
  RESULTS
  There were 110,783 pregnancies during the study period: 109,544 singleton births and 1239 pregnancy terminations for medical reasons. In total, 5267 mothers were exposed to NSAID during the first trimester of pregnancy: 5153 to nonselective COX inhibitors and 114 to COX-2 selective inhibitors. Exposure to NSAID in the first trimester, as groups (nonselective COX and selective COX-2 inhibitors) and as individual drugs, was not associated with an increased risk of major congenital malformations in general (adjusted OR 1.07, 95% CI 0.96-1.21 for nonselective; and adjusted OR 1.40, 95% CI 0.70-2.78, for selective COX-2 inhibitors), although an increased risk for musculoskeletal malformations was found following exposure to COX-2 selective inhibitors (adjusted OR 3.39, 95% CI 1.37-8.34).
  
  
  CONCLUSIONS
  Intrauterine exposure to NSAID was not associated with increased risk for major congenital malformations. Further studies are needed to assess the risk for malformations after exposure to COX-2 selective inhibitors.
authors.affiliation: Department of Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev, and Soroka Medical Center, Beer Sheva, Israel.
authors.forename: Sharon
authors.initials: S
authors.lastname: Daniel
authors.forename: Ilan
authors.initials: I
authors.lastname: Matok
authors.forename: Rafael
authors.initials: R
authors.lastname: Gorodischer
authors.forename: Gideon
authors.initials: G
authors.lastname: Koren
authors.forename: Elia
authors.initials: E
authors.lastname: Uziel
authors.forename: Arnon
authors.initials: A
authors.lastname: Wiznitzer
authors.forename: Amalia
authors.initials: A
authors.lastname: Levy
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D015331:Cohort Studies; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects*; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007557:Israel; D008875:Middle Aged; D009139:Musculoskeletal Abnormalities / Q000139:chemically induced / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced / Q000453:epidemiology; D011261:Pregnancy Trimester, First; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors