Nonsteroidal anti-inflammatory drugs: the need for assessment and education

Evaluation of the effect of indomethacin and piroxicam administration before embryo transfer on pregnancy rate

AIM

The aim of this study was to evaluate the effect of non-steroidal anti-inflammatory drug (NSAID) administration before embryo transfer (ET) on pregnancy rates in women undergoing in vitro fertilization/intracytoplasmic sperm injection ET.

METHODS

Our study included 255 patients diagnosed with primary or secondary infertility caused by a male or tubal-related factor, endometriosis or unexplained factors. The patients were divided randomly into three groups. Two groups were administered oral piroxicam (10 mg capsules) or 100 mg indomethacin (rectal suppository), respectively, 1-2 h before ET. As a control, the third group did not receive any form of treatment before ET. Basal levels of follicle-stimulating hormone, luteinizing hormone, and level 17β-estradiol on the day of human chorionic gonadotropin administration, the collected and transferred number of embryos, and the number of grade A embryos obtained were determined in all patients.

RESULTS

The implantation, clinical pregnancy, and miscarriage rates of the groups were compared. The clinical pregnancy rate per ET and the implantation rate were 35.2% and 12.15% in the piroxicam group, 31.7% and 10.9% in the indomethacin group, and 32.9% and 12.5% in the control, respectively. The miscarriage rates of groups 1, 2 and 3 were 12%, 11.7% and 11.7%, respectively (P = 0.964). The differences in clinical pregnancy rates among the groups were not statistically significant (P = 0.887). There were also no significant differences in the implantation rates (P = 0.842).

CONCLUSION

These results suggest that NSAID administration before ET has no additional effect on pregnancy outcome in patients undergoing in vitro fertilization.

A Comparison of Educational Methods to Improve NSAID Knowledge and Use of a Medication List in an Elderly Population

The objective of this study is to compare the effectiveness of pharmacist-provided individualized education with standardized video education for(a) improving patient understanding of gastropathy caused by nonsteroidal anti-inflammatory drugs (NSAIDs) and (b) stimulating the use of a medication list. Home care patients were assessed and then randomized to receive either video education or a tailored intervention from a home care pharmacist. Patients in the tailored group were more likely to keep an updated list (p = .033) and utilize it before purchasing over-the-counter medications (p = .043). Tailored education may be more effective than standardized video education for changing behaviors related to NSAID-induced gastropathy.

Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: population based cohort study

OBJECTIVE

To evaluate whether prenatal use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with increased risk of miscarriage.

DESIGN

Population based cohort study. Prenatal use of NSAIDs, aspirin, and paracetamol (acetaminophen) ascertained by in-person interview.

SETTING

Kaiser Permanente Medical Care Program, a healthcare delivery system, in the San Francisco area of the United States.

PARTICIPANTS

1055 pregnant women recruited and interviewed immediately after their positive pregnancy test. Median gestational age at entry to the study was 40 days.

MAIN OUTCOME MEASURES

Pregnancy outcomes up to 20 weeks of gestation.

RESULTS

53 women (5%) reported prenatal NSAID use around conception or during pregnancy. After adjustment for potential confounders, prenatal NSAID use was associated with an 80% increased risk of miscarriage (adjusted hazard ratio 1.8 (95% confidence interval 1.0 to 3.2)). The association was stronger if the initial NSAID use was around the time of conception or if NSAID use lasted more than a week. Prenatal aspirin use was similarly associated with an increased risk of miscarriage. However, prenatal use of paracetamol, pharmacologically different from NSAIDs and aspirin, was not associated with increased risk of miscarriage regardless of timing and duration of use.

CONCLUSION

Prenatal use of NSAIDs and aspirin increased the risk of miscarriage. These findings need confirmation in studies designed specifically to examine the apparent association.