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Safety of pain therapy during pregnancy and lactation in patients with inflammatory arthritis: a systematic literature review.
J Rheumatol Suppl 2012; 90:59-61JR

Abstract

OBJECTIVE

To systematically review the safety of various pain therapies used during pregnancy and lactation in patients with inflammatory arthritis.

METHODS

A systematic literature review was performed in Medline, Embase, the Cochrane Library, and the American College of Rheumatology/European League Against Rheumatism 2008-2009 meeting abstracts, as part of the multinational 3e (Evidence, Expertise, Exchange) Initiative for generating practical recommendations about Pain Management by Pharmacotherapy in Inflammatory Arthritis. Articles fulfilling predefined inclusion criteria were reviewed, and quality appraisal was performed.

RESULTS

The search yielded a total of 3974 articles and 7 abstracts. The only study that fulfilled the criteria for pain therapies in pregnancy was a systematic review published in 2008, evaluating the effects of nonsteroidal antiinflammatory drug (NSAID) use during pregnancy in patients with rheumatic conditions. Two of the 3 studies reviewed in the 2008 publication could be included in our current review. No studies were included in the review in relation to lactation. A total of 204 malformations were identified among infants exposed to NSAID, with an OR of 1.04. The number of identified cardiac defects was higher than expected, with an OR of 1.86. There seemed to be no specificity for the type of NSAID used. Among the 6 infants with orofacial clefts, 5 occurred with naproxen use and 1 with ibuprofen.

CONCLUSION

Only 2 studies evaluating the risk of NSAID use in patients with inflammatory arthritis were identified, with results suggesting a higher rate of cardiac malformations in infants exposed to NSAID during the first trimester. No studies evaluating the effects of other treatments, such as paracetamol, corticosteroids, muscle relaxants, neuromodulators, antidepressants, opioids, or opioid-like therapy in the specific context of rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, or spondyloarthritis, and no studies with respect to lactation were identified. Research is needed to improve the risk-benefit ratio of the use of pain therapies for inflammatory arthritis during pregnancy.

Authors+Show Affiliations

Department of Internal Medicine, Rheumatology Service, Centre Hospitalier Universitaire de l'Université Laval, Québec, Quebec, Canada. karen.adams@utoronto.caNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

22942331

Citation

Adams, Karen, et al. "Safety of Pain Therapy During Pregnancy and Lactation in Patients With Inflammatory Arthritis: a Systematic Literature Review." The Journal of Rheumatology. Supplement, vol. 90, 2012, pp. 59-61.
Adams K, Bombardier C, van der Heijde DM. Safety of pain therapy during pregnancy and lactation in patients with inflammatory arthritis: a systematic literature review. J Rheumatol Suppl. 2012;90:59-61.
Adams, K., Bombardier, C., & van der Heijde, D. M. (2012). Safety of pain therapy during pregnancy and lactation in patients with inflammatory arthritis: a systematic literature review. The Journal of Rheumatology. Supplement, 90, pp. 59-61. doi:10.3899/jrheum.120344.
Adams K, Bombardier C, van der Heijde DM. Safety of Pain Therapy During Pregnancy and Lactation in Patients With Inflammatory Arthritis: a Systematic Literature Review. J Rheumatol Suppl. 2012;90:59-61. PubMed PMID: 22942331.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Safety of pain therapy during pregnancy and lactation in patients with inflammatory arthritis: a systematic literature review. AU - Adams,Karen, AU - Bombardier,Claire, AU - van der Heijde,Désirée M, PY - 2012/9/4/entrez PY - 2012/9/4/pubmed PY - 2013/1/18/medline SP - 59 EP - 61 JF - The Journal of rheumatology. Supplement JO - J Rheumatol Suppl VL - 90 N2 - OBJECTIVE: To systematically review the safety of various pain therapies used during pregnancy and lactation in patients with inflammatory arthritis. METHODS: A systematic literature review was performed in Medline, Embase, the Cochrane Library, and the American College of Rheumatology/European League Against Rheumatism 2008-2009 meeting abstracts, as part of the multinational 3e (Evidence, Expertise, Exchange) Initiative for generating practical recommendations about Pain Management by Pharmacotherapy in Inflammatory Arthritis. Articles fulfilling predefined inclusion criteria were reviewed, and quality appraisal was performed. RESULTS: The search yielded a total of 3974 articles and 7 abstracts. The only study that fulfilled the criteria for pain therapies in pregnancy was a systematic review published in 2008, evaluating the effects of nonsteroidal antiinflammatory drug (NSAID) use during pregnancy in patients with rheumatic conditions. Two of the 3 studies reviewed in the 2008 publication could be included in our current review. No studies were included in the review in relation to lactation. A total of 204 malformations were identified among infants exposed to NSAID, with an OR of 1.04. The number of identified cardiac defects was higher than expected, with an OR of 1.86. There seemed to be no specificity for the type of NSAID used. Among the 6 infants with orofacial clefts, 5 occurred with naproxen use and 1 with ibuprofen. CONCLUSION: Only 2 studies evaluating the risk of NSAID use in patients with inflammatory arthritis were identified, with results suggesting a higher rate of cardiac malformations in infants exposed to NSAID during the first trimester. No studies evaluating the effects of other treatments, such as paracetamol, corticosteroids, muscle relaxants, neuromodulators, antidepressants, opioids, or opioid-like therapy in the specific context of rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, or spondyloarthritis, and no studies with respect to lactation were identified. Research is needed to improve the risk-benefit ratio of the use of pain therapies for inflammatory arthritis during pregnancy. SN - 0380-0903 UR - https://www.unboundmedicine.com/medline/citation/22942331/Safety_of_pain_therapy_during_pregnancy_and_lactation_in_patients_with_inflammatory_arthritis:_a_systematic_literature_review_ L2 - http://www.jrheum.org/cgi/pmidlookup?view=long&pmid=22942331 DB - PRIME DP - Unbound Medicine ER -