HQ Team
December 28, 2024: A study from Taiwan links the use of nonsteroidal anti-inflammatory drugs (NSAIDs) during pregnancy, with a potential risk of chronic kidney disease (CKD) in children.
The researchers analyzed data from a national population-based cohort of over 1 million children born between 2007 and 2017. The findings revealed that gestational exposure to certain NSAIDs significantly increases the risk of childhood CKD, particularly when these medications are used during specific trimesters:
First Trimester risks: Indomethacin and ketorolac were associated with heightened risk.
Second Trimester concerns: Mefenamic acid and diclofenac usage raised risk levels.
Third Trimester: Ibuprofen was linked to increased CKD risk.
Dr. You-Lin Tain, lead author of the study, stated, “To our knowledge, this is the first population-based cohort study in 15 years to investigate the association of gestational exposure to NSAIDs and childhood CKD,” underscoring the significance of these findings.
The U.S. Centers for Disease Control and Prevention (CDC) estimates that approximately 35.5 million adults in the U.S. have CKD, with many unaware of their condition. The study suggests that exposure to nephrotoxic medications during fetal development may increase this risk later in life. The U.S. Food and Drug Administration (FDA) has previously warned that NSAID use after 20 weeks of pregnancy could lead to serious kidney issues in unborn children, including oligohydramnios—low amniotic fluid levels that can impair fetal development.
Examples of NSAIDs include aspirin, ibuprofen, diclofenac, celecoxib, and naproxen, that relieve cold and flu symptoms, such as cough, headaches, and fever, as well as provide relief for arthritis pain or insomnia.
Study methodology
The researchers utilized data from the Taiwan National Maternal and Child Health Database and assessed maternal NSAID exposure through prescription records. Out of 1,025,255 children studied, 24% had mothers who used NSAIDs during pregnancy. The analysis tracked childhood CKD diagnoses over a median follow-up period of nearly ten years. The results indicated that gestational NSAID exposure was significantly associated with a higher risk of childhood CKD (weighted hazard ratio [wHR], 1.10). Notably, risks were particularly pronounced during the second (wHR, 1.19) and third trimesters (wHR, 1.12).
Limitations of the study
Research was based solely on prescription records, “potentially leaning to exposure misclassification if actual NSAID use differed,” Chien-Ning Hsu, PhD, of Kaohsiung Chang Gung Memorial Hospital in Taiwan, and colleagues noted. Also, maternal factors like malnutrition and micronutrient deficiencies, as well as behaviors like smoking and alcohol consumption that can influence kidney outcomes, were not accounted for, they added.
Future research
Given these findings, healthcare providers are urged to exercise caution when prescribing NSAIDs to pregnant women. The study authors recommend thorough assessments of benefits and risks before prescribing these medications. Dr. Tain concluded, “Future research should investigate the specific roles of genetic and environmental factors in kidney development across different stages of pregnancy,” emphasizing the need for ongoing studies to better understand these associations.
The study is available in Jama Network.
