Use of non-steroidal anti-inflammatory drugs in pregnancy and oligohydramnios: a review

Abstract

Objective

The aim of this review is to evaluate the relationship between the use of non-steroidal anti-inflammatory drugs (NSAIDs) during last trimesters of the pregnancy and the reduction of amniotic fluid.

Methods

Electronic databases were searched (PubMed, Medline, and Scopus). Selection criteria included studies reporting the relationship between oligohydramnios and use of NSAID during pregnancy. We analyzed the median age of women, weeks of pregnancy at the beginning of the drug administration, kind of medication, period of exposure and dosage, deepest vertical pocket (DVP), and amniotic fluid index (AFI).

Results

Of the 68 records identified, we analyzed 29 studies investigating the administration of NSAIDs, including 11 studies examined the administration of the Indomethacin, four articles have focused on the use of Nimesulide, and only two manuscripts considered the use of Diclofenac. We found a strict correlation between the development of oligohydramnios and the use of NSAIDs. The oligohydramnios is reversible, and the normal amount of amniotic fluid is restored after the interruption of the treatment.

Conclusions

The use of NSAIDs should be considered when maternal benefits outweigh the potential fetal risk, at the lowest effective dose for shortest duration. Beyond 48 h of NSAIDs treatment, we consider ultrasound monitoring of amniotic fluid, and we suggest stopping therapy if a decline AFI is present.

Keywords:

• Oligohydramnios
• non-steroidal anti-inflammatory drugs
• fetal outcome
• pregnancy
• adverse drug effects

Author contributions

AS: conception, planning, analysis, and writing. VD: planning, analysis, and writing. FV, GS, AS, and DD: conception, planning, analysis, and writing. VD: conception, planning, and writing. RB and AG: conception, planning, and final approval of the work.

Disclosure statement

The authors report no conflict of interest.

Data availability statement

All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author [email protected]

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.