Caution urged when prescribing NSAIDs in pregnancy in relation to kidney health in offspring

Prenatal exposure to nonsteroidal anti-inflammatory drugs (NSAIDs) has the potential to harm the offspring’s kidney health, highlighting the need for caution when prescribing NSAIDs during pregnancy, according to a large study from Taiwan.

Researchers looked at 1,025,255 children born alive in Taiwan. They assessed the risk of chronic kidney disease (CKD) in childhood in relation to maternal prescriptions for NSAIDs from the last menstrual period to birth. Childhood CKD, the main outcome, included congenital anomalies of the kidney and urinary tract and other kidney diseases.

The analysis included 163,516 singleton-born children (24.0 percent) whose mothers (mean age at birth of child 31.25 years) used at least one dispensing of an NSAID during pregnancy. Cox proportional hazards regression models with stabilized inverse probability of treatment weighting and a robust sandwich estimator were used.

Gestational NSAID exposure was associated with a 10-percent higher risk of childhood CKD (weighted hazard ratio [wHR], 1.10, 95 percent confidence interval [CI], 1.05–1.15). However, sibling comparisons yielded a null association.

On further analysis, NSAID exposure during the second trimester was associated with elevated risk of childhood CKD (wHR, 1.19, 95 percent CI, 1.11–1.28), as was exposure during the third trimester (wHR, 1.12, 95 percent CI, 1.03–1.22).

Looking at specific NSAID exposures, higher childhood CKD risk was observed for first-trimester exposure to indomethacin (wHR, 1.69, 95 percent CI, 1.10–2.60) and ketorolac (wHR, 1.28, 95 percent CI, 1.01–1.62), second-trimester exposure to diclofenac (wHR, 1.27, 95 percent CI, 1.13–1.42) and mefenamic acid (wHR, 1.29, 95 percent CI, 1.15–1.46), and third-trimester exposure to ibuprofen (wHR, 1.34, 95 percent CI, 1.07–1.68).