title: Racial differences in risk of spontaneous abortions associated with periconceptional over-the-counter nonsteroidal anti-inflammatory drug exposure.
abstract: OBJECTIVE
  Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most common medications reported in pregnancy. NSAIDs directly impact prostaglandin pathways and have been proposed as potential risk factors for spontaneous abortions (SABs, gestation <20 weeks). SAB risk and drug response across several medications differ by race; therefore, we evaluated whether associations between NSAIDs and SAB risk differ by race.
  
  
  METHODS
  Women were enrolled in the Right from the Start (2004-2010) prospective cohort. Data regarding over-the-counter NSAIDs up to the sixth week of pregnancy were obtained from interviews. Race was self-reported. Cox proportional hazards regression models were used to estimate the association between NSAID exposure and SAB, adjusted for confounders.
  
  
  RESULTS
  Among 2493 pregnancies, 12% were African American and 88% were Caucasian. NSAID exposure was reported by 40% (n = 124) of African Americans and 43% (n = 945) of Caucasians. Race-stratified analyses showed protection from SAB among African Americans (adjusted hazard ratio [aHR], 0.84; 95% confidence interval [CI], 0.73-0.96) but no effect in Caucasians (aHR, 1.01; 95% CI 0.88-1.16).
  
  
  CONCLUSIONS
  Our findings suggest that risk for SAB due to over-the-counter NSAIDs in early pregnancy is modified by race. Further investigation of dose, timing in gestation, and indication may help to further reconcile the relationship between race, NSAIDs, and SAB.
authors: Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, TN; Institute of Medicine and Public Health, Vanderbilt University, Nashville, TN; Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, TN; Center for Human Genetics Research, Vanderbilt University, Nashville, TN. Electronic address: digna.r.velez.edwards@vanderbilt.edu.
authors: Digna R
authors: DR
authors: Velez Edwards
authors: Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, TN; Institute of Medicine and Public Health, Vanderbilt University, Nashville, TN; Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, TN.
authors: Katherine E
authors: KE
authors: Hartmann
mesh_terms: D000022:Abortion, Spontaneous / Q000139:chemically induced* / Q000208:ethnology*; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005865:Gestational Age; D054625:Healthcare Disparities; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D004366:Nonprescription Drugs / Q000009:adverse effects* / Q000627:therapeutic use; D011247:Pregnancy; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First / Q000187:drug effects*; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004366:Nonprescription Drugs
keywords: Disparity; Miscarriage; Nonsteroidal anti-inflammatory drugs; Pregnancy; Toxicology