Some Over-the-Counter Pain Drugs Linked to Severe Newborn Illness

March 5, 2001 -- If you're pregnant, your life can seem like an unending list of "don'ts." You probably know to avoid unnecessary medications. But what about that aspirin or ibuprofen (Advil, Motrin) you take for a nagging headache? Since these medications are available without a prescription, do they even count? Absolutely.

Aspirin, ibuprofen, and naproxen belong to a medication class known as nonsteroidal anti-inflammatory drugs, also called NSAIDs. These medications are often used to treat aches and pains, but because they're often available without prescription, many people don't think of them as drugs.

However, just because you don't need a prescription to get them doesn't necessarily mean that they're safe to use -- especially when you're pregnant.

According to new research in the March issue of Pediatrics, there may be a link between NSAID use by mothers and a serious respiratory condition in newborns known as persistent pulmonary hypertension. This condition is characterized by a stiffening of the blood vessels in the lungs. Infants with pulmonary hypertension are typically treated in the intensive care unit, often require ventilator support, and are at high risk of dying from this illness.

In the study, investigators compared the first bowel movements of infants with pulmonary hypertension to those of healthy infants. They found that the affected infants were far more likely to test positive for exposure to at least one NSAID drug, typically aspirin.

An infant's first bowel movement contains a substance called meconium, which begins forming relatively early in pregnancy. Because meconium is typically not passed until after birth, medications the mother has taken throughout the pregnancy may be present in the substance.

Among all of the infants with pulmonary hypertension, the meconium analysis was positive for NSAID exposure for nearly half. However, less than 28% of the mothers had disclosed that they had taken any NSAIDs during the pregnancy.

"Pregnant women should be cautious in taking any drugs, particularly if they do not know what they contain," co-author Enrique M. Ostrea, MD, tells WebMD. " should know of the risks associated with NSAIDs, in particular. More regulation of labeling would also help, so that the mothers know the risks and benefits of taking medications." Ostrea is a professor of pediatrics at Wayne State University School of Medicine in Detroit, where he is chief of pediatrics at Hutzel Hospital.

Most of the infants in the study who had pulmonary hypertension required ventilator support for an average of 11 days. About 35% of them were severely ill and required treatment with a device similar to a heart-lung machine. Two of the infants subsequently died.

While a high percentage of the sick children in the study had been exposed to NSAIDs, this does not mean that NSAIDs cause pulmonary hypertension, several experts caution. However, they advocate that pregnant women avoid this medication class.

"Pregnant women generally need to avoid NSAIDs in pregnancy," Steven Goldstein, MD, tells WebMD. "I encourage patients to use nonpharmacologic measures first for pain relief and also to see if acetaminophen is effective." When you're pregnant, the first response to pain shouldn't be to reach in the medicine cabinet, says Goldstein, a professor of obstetrics and gynecology at New York University Medical Center.

"This is a good study of a relatively rare disease that shows how often patients underreport the medications they're taking," says Lynn Simpson, MD, the director of labor and delivery at New York-Presbyterian Hospital in New York City. "The discrepancy between the [mother's] report and fetus' meconium is very striking."

The study was funded in part by a grant from the National Heart, Lung, and Blood Institute.