Over-the-counter analgesics during pregnancy: a comprehensive review of global prevalence and offspring safety

Aikaterini Zafeiri, Rod T Mitchell, David C Hay, Paul Fowler

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background: Analgesia during pregnancy is often necessary. Due to their widespread availability, many mothers opt to use over-the-counter (OTC) analgesics.Those analgesic compounds and their metabolites can readily cross the placenta and reach the developing fetus. Evidence for safety or associations with adverse health outcomes is conflicting, limiting definitive decision-making for healthcare professionals.
Objective and rationale: This review provides a detailed and objective overview of
research in this field. We consider the global prevalence of OTC analgesia during
pregnancy, explain current mechanistic understanding of how analgesic compounds cross the placenta and reach the fetus, and review current research on exposure associations with offspring health outcomes.
Search Methods: A comprehensive English language literature search was
conducted using PubMed and Scopus databases. Different combinations of key
search terms were used including “over-the-counter/non-prescription analgesics”, “pregnancy”, “self-medication”, “paracetamol”, “acetaminophen”, “diclofenac”, “aspirin”, “ibuprofen”, “in utero exposure”, “placenta drug transport”, “placental transporters”, “placenta drug metabolism” and “offspring outcomes”.
Outcomes: This article examines the evidence of fetal exposure to OTC analgesia,
starting from different routes of exposure to evidence, or the lack thereof, linking
maternal consumption to offspring ill health. There is a very high prevalence of
maternal consumption of OTC analgesics globally, which is increasing sharply. The choice of analgesia selected by pregnant women differs across populations. Location was also observed to have an effect on prevalence of use, with more developed countries reporting the highest consumption rates. Some of the literature focuses on the association of in utero exposure at different pregnancy trimesters and the development of neurodevelopmental, cardiovascular, respiratory, reproductive defects. This is in contrast to other studies which report no associations.
Wider implications: The high prevalence and the challenges of reporting exact
consumption rates make OTC analgesia during pregnancy a pressing reproductive
health issue globally. Even though some healthcare policy-making authorities have declared consumption of some OTC analgesics for most stages of pregnancy safe, such decisions are often based on partial review of literature. Our comprehensive review of current evidence highlights that important knowledge gaps still exist. Those areas require further research in order to provide pregnant mothers with clear guidance with regard to OTC analgesic use during pregnancy.
Original languageEnglish
JournalHuman Reproduction Update
Publication statusPublished - 29 Oct 2020


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