Prenatal acetaminophen use in women with autoimmune disorders and adverse pregnancy and birth outcomes

Short-term side effects following COVID-19 vaccination in pregnancies complicated by autoimmune inflammatory rheumatic diseases: A prospective cohort study

BACKGROUND

Pregnant women are at higher risk for severe Coronavirus disease 2019 (COVID-19) infection, leading the Centers for Disease Control and Prevention to recommend vaccination. However, the frequency of vaccine side effects in pregnant women with autoimmune inflammatory rheumatic diseases (AIIRD) remains unknown. We investigated the frequencies of short-term (≤ 7 days) adverse reactions following the initial COVID-19 vaccination ever received by pregnant women with AIIRD.

METHODS

A descriptive analysis of the incidence of side effects following the COVID-19 vaccination in pregnant women with AIIRD was conducted utilizing data from the MotherToBaby Study registry, a prospective cohort study designed to assess the safety of drug and vaccine exposure during pregnancy. This study enrolled pregnant women living in the United States or Canada between January 2021 and September 2022.

RESULTS

Of 1413 participants who received dose 1 of the COVID-19 vaccine in pregnancy, 79 had AIIRD. There was no large difference in the total number of adverse reactions between pregnant women with and without AIIRD (β = -0.01, 95 % Confidence Interval [CI]: -0.17, 0.17). Pregnant women with higher Health Assessment Questionnaire Disability Index (HAQ-DI) in AIIRD had a higher total number of systemic reactions (β = 0.56, 95 % CI: 0.04, 1.10) than those with lower HAQ-DI, although the total number of adverse reactions was not different (β = 0.27, 95 % CI: -0.08, 0.62).

CONCLUSIONS

We found no difference in the frequency of COVID-19 vaccine-related side effects between pregnant women with and without AIIRD. Patients with AIIRD who have higher levels of functional impairment may have a slightly higher frequency of short-term adverse effects. The results of this assessment may help provide information for pregnant women with AIIRD regarding COVID-19 vaccination.

A quantitative weight-of-evidence review of preclinical studies examining the potential developmental and reproductive toxicity of acetaminophen

We previously developed a quantitative weight-of-evidence (QWoE) framework using prespecified scoring criteria for preclinical acetaminophen data to characterize potential developmental neurotoxicity outcomes with considerations for biological relevance of the response to adverse outcomes and the strength of methods and study design. The current analysis uses this framework to characterize potential developmental and reproductive toxicity (DART) outcomes following exposure to acetaminophen. Two-hundred forty-two QWoE entries were documented from in vivo rodent studies identified in 110 publications across five categories: DART endpoints in the context of (1) periadolescent/adulthood (nonpregnancy) exposures; (2) pregnant female exposures; and, for in utero or other developmental exposures, (3) anatomical abnormalities, (4) reproductive development, and (5) other physical development. A mean outcome score and methods score were calculated for 242 QWoE entries. Data analyzed in our framework were of moderate quality showing no consistent evidence of DART in male and female rodents following exposure to acetaminophen at therapeutic and/or non-systemically toxic doses. Similar results were found for the individual context- and outcome-related endpoint analyses and as segregated by sex. Overall, this QWoE analysis on the in vivo rodent data demonstrated no consistent evidence of adverse effects following exposure to therapeutic and/or non-systemically toxic acetaminophen on development or on the structure and function of the reproductive system.

Abortive and Prophylactic Therapies to Treat Migraine in Pregnancy: A Review

Migraine is a common issue during pregnancy, often affected by hormonal changes. More than half of the women affected by migraine experience improvement in or remission of migraine symptoms, particularly during the second and third trimesters, with those having menstrual migraines or migraines without aura benefiting the most. However, a small percentage of women may see a worsening of their migraines, especially those with migraine with aura, and some may even develop migraines for the first time during pregnancy, often in the first trimester. Postpartum, many women experience a recurrence of migraines, likely due to the drop in estradiol and endorphin levels. A literature search was performed in PubMed for articles published from 2013 through 2023, and 80 out of 362 publications were included. When it comes to managing pregnant women with migraine, non-pharmacological treatments are preferred, including lifestyle modifications and avoiding known triggers. When medication is necessary, acetaminophen is the first-line treatment, with nonsteroidal anti-inflammatory drugs and triptans regarded as secondary options, though trimester-specific risks limit their use. Preventive treatments, if required, may include low doses of β-blockers or amitriptyline but should be used cautiously. This article aims to provide a concise overview of the existing research on the acute and prophylactic use of medications to treat migraines in pregnant and lactating women. Furthermore, it presents recommendations for healthcare professionals managing pregnant females presenting with migraine in clinical settings.

Association of acetaminophen use with perinatal outcomes among pregnant women: a retrospective cohort study with propensity score matching

BACKGROUND

Although acetaminophen is widely used in women during pregnancy, its safety has not been clearly stated. The study aimed to investigate the association between acetaminophen use and adverse pregnancy outcomes in pregnant women in China.

METHODS

We conducted a retrospective cohort study by collecting data on pregnant women who delivered in the Beijing Obstetrics and Gynecology Hospital from January 2018 to September 2023. An acetaminophen use group and a control group were formed based on prenatal exposure to acetaminophen. The pregnancy outcomes that we focused on were stillbirth, miscarriage, preterm birth, APGAR score, birth weight, and congenital disabilities. Pregnant women exposed to acetaminophen were matched to unexposed in a 1:1 ratio with propensity score matching, using the greedy matching macro. SPSS software was used for statistical analysis. Multivariable logistics regression was used to assess the association between acetaminophen use during pregnancy and adverse pregnancy outcomes.

RESULTS

A total of 41,440 pregnant women were included, of whom 501 were exposed to acetaminophen during pregnancy, and 40,939 were not exposed. After the propensity score matching, the acetaminophen use and control groups consisted of 501 pregnant women each. The primary analysis showed that acetaminophen exposure during pregnancy was associated with an increased risk of stillbirth (adjusted OR (aOR) = 2.29, 95% CI, 1.19-4.43), APGAR score < 7 at 1 min (aOR = 3.28, 95% CI, 1.73-6.21), APGAR score < 7 at 5 min (aOR = 3.54, 95% CI, 1.74-7.20), APGAR score < 7 at 10 min (aOR = 3.18, 95% CI, 1.58-6.41), and high birth weight (HBW) (aOR = 1.75, 95% CI, 1.05-2.92). Drug exposure during the first and second trimesters increased the odds of stillbirth, miscarriage, APGAR < 7, and the occurrence of at least one adverse pregnancy outcome. In addition, the frequency of drug use more than two times was associated with a higher risk of preterm birth and APGAR score < 7.

CONCLUSIONS

Exposure to acetaminophen during pregnancy was significantly associated with the occurrence of adverse pregnancy outcomes, particularly exposure in the first and second trimesters and frequency of use more than twice. It is suggested that acetaminophen should be prescribed with caution in pregnant women.

Associations of prenatal exposure to non-steroidal anti-inflammatory drugs with preterm birth and small for gestational age infants among women with autoimmune disorders

PURPOSE

Estimate associations between prenatal non-steroidal anti-inflammatory (NSAID) exposure and preterm birth and small for gestational age among women with autoimmune conditions.

METHODS

Participants were enrolled in the MotherToBaby cohort and had an autoimmune disorder and singleton live birth >20 weeks gestation (n = 2007). We characterized self-reported NSAID exposure over gestation for timing, duration, and average daily dose. Outcomes were preterm birth (i.e., <37 weeks' gestation) and small for gestational age infants (SGA; <10th percentile birthweight). We used Poisson regression to estimate associations between NSAID exposure and study outcomes adjusting for demographics, co-use of other medications (Model 1), and disease severity at baseline (Model 2). Secondarily, we considered the role of acetaminophen use by individually matching NSAID users to controls on cumulative dose of acetaminophen exposure.

RESULTS

Overall, 15% of women reported NSAID use in pregnancy, with most use in the first trimester. No NSAID use exposure variables were associated with risk of preterm birth. Any NSAID use was associated with 1.7 (95% CI 1.2, 2.5) times greater risk of SGA and this estimate was attenuated to 1.5 (95% CI 1.0, 2.3) after adjustment for baseline disease severity. NSAID exposure in the first trimester was most strongly associated with SGA. After matching on acetaminophen exposure, associations between any NSAID use and preterm birth and SGA were 0.9 (95% CI 0.6, 1.4) and 1.8 (95% CI 1.1, 2.9).

CONCLUSIONS

NSAID use in pregnancy is associated with SGA but not preterm birth. Future research should explore mechanisms that may explain these findings. Future research must also consider alternative explanations for these associations.