Tag Archives: pregnancy

NSAIDs raise miscarriage risk

Photograph of abdomen of a pregnant woman

Image via Wikipedia

A recently published study in the Canadian Medical Association Journal has concluded that women who take NSAIDs in the first trimester of pregnancy are more than twice as likely to have a miscarriage than women who do not.

NSAIDs, or non-steroidal anti-inflammatory drugs, are a very popular class of pain killers that many people use every day.  They are also used to reduce fever.  The new study investigated use of non-aspirin NSAIDs such as ibuprofen, naproxen and other drugs.

It is estimated that about 17% of women use non-aspirin NSAIDs during pregnancy despite the already existing knowledge they can cause malformations.

The problem with this is NSAIDs are seen by many patients as basically harmless medications because their use is so incredibly common.  NSAIDs are also available over-the-counter and do not require a prescription to buy.  There is nothing stopping a pregnant woman from going to her local CVS and buying a bottle of Motrin to alleviate that pesky headache or continuing to medicate her chronic back pain.

The Canadian study compared the medical records of 4,705 women who had a miscarriage during the first 20 weeks of gestation with records of 47,050 women who became pregnant and delivered a child. The women in the study were aged 15 to 45 when they became pregnant.

Among women who had miscarriages, 352 had taken NSAIDs, compared with 1,213 of the women who did not experience pregnancy loss.

When calculating the risk associated with NSAID use, the researchers accounted for other factors that might increase the likelihood of miscarriage, such as diabetes, high blood pressure, heart disease, asthma, lupus, rheumatoid arthritis, depression and anxiety.

Taking into account all of that information, the risk for miscarriage was 35% for women taking NSAIDs as compared to the usual rate of 15%.  That jump is quite significant.  Imagine if the average miscarriage rate was actually 35% and not 15%.  That would mean more than one out of every three women who became pregnant would have miscarriages.  That would truly be a worrisome number.

To me, this signifies that we need to stress to pregnant women that they should seek more conservative ways to manage their pain.  Head aches, neck pain, back pain, cramping and many other forms of pain are things that chiropractors deal with on a daily basis with success.  There is very little side effect, if any, to manipulation.  And there certainly isn’t an increased risk of miscarriage!

In traditional medical care NSAIDs are thought of as conservative care.  I doubt there are many responsible medical physicians who would recommend a pregnant woman take an NSAID because of the risk already associated with them, but the problem is they don’t have to.  These drugs are so readily available and people have been taught this is an acceptable form of conservative care.  They are not.  Additionally, they provide only temporary relief. Chiropractic care actually addresses the issues at hand and is corrective.  This is something an NSAID can never claim to be.

Most people, pregnant or not, deal with some form of pain from time to time.  Still others deal with it frequently. Unfortunately, most of those people reach for the bottle of pills to relieve the pain but not actually correct the problem that’s causing it.  Next time that happens, consider trying chiropractic as an option.  Not only will it relieve your pain, it will fix the problem too!

Advertisements

1 Comment

Filed under Big Pharma, Public Health

Fish Oil and your Baby’s Health

Fish oil caps

Image by Stephen Cummings via Flickr

A recent study published in the Journal of the American Medical Association has concluded that “the use of DHA-rich fish oil capsules compared with vegetable oil capsules during pregnancy did not result in lower levels of postpartum depression in mothers or improved cognitive and language development in their offspring during early childhood.”

The ingredient they tested, docosahexaenoic acid, or DHA, has been shown repeatedly in other studies to be helpful for women and their babies.  Unfortunately, this study, because of where it has been published, will get all the headlines and I fear that some people will decide that fish oil during pregnancy is unnecessary.  This couldn’t be further from the truth.

This study followed roughly 2400 women from less than 21 weeks gestation to birth and analyzed data regarding the mother’s mood postpartum and the child’s cognitive development at 18 months.  Half of the participants were given fish oil containing 800mg/day of DHA and half were given a vegetable oil placebo.  What the study found was that depression scores in women taking the DHA were the same as the women taking the placebo and the cognitive development of the children was the same at 18 months regardless of intervention.  While you cannot argue with the findings of the study (they found what they found) I do have a problem with the implications this makes for high DHA fish oil.

Many studies have concluded that fish oil and DHA in particular is important for improving brain function.  Observational studies have shown that consumption of fish oil reduces postpartum depression and raises the I.Q. of children.  This is in direct contrast to what this study has concluded.  A 2003 study showed that children with higher levels of DHA had higher I.Q. scores at age 4 than controls.

Other benefits are known as well.  Fish are a rich source of long-chain omega-3 polyunsaturated fatty acids (PUFA), essential nutrients that have important structural and physiological roles in several body systems, including neurological, immune, and cardiovascular. Because humans cannot synthesize omega-3s, these nutrients must be consumed in the diet. Conversion from the parent omega -3, (linolenic acid), to the more biologically active long-chain omega-3 DHA and eicosapentaenoic acid (EPA), is inefficient and therefore consumption of some preformed omega-3 is important for optimal health.

Possible Flaws

Perhaps this recent study was unable to properly assess cognitive performance at 18 months.  It is much easier to assess in a 4 year old.  Also, the benefits may not be seen until later in life.  In a society where we want results immediately it is easy to understand why they would try and observe for the benefits of DHA at only 18 months.  However, a very real possibility exists; maybe these benefits are not observable that quickly.  Are the negative effects of a bad diet on heart disease observable in a 20 year old?  Of course not.  We must wait much longer (perhaps until the person is at least 45) to clearly see the cause and effect relationship. This example perfectly illustrates the fact that not all relationships are readily available directly after treatment.  Unfortunately, these studies continue to employ a drug based research approach to nutrition.  They are separate entities and need to be researched accordingly.

Another possible flaw is that they did not assess dietary intake of omega-3s in the study participants.  This is problematic because it is possible patients already had enough DHA to provide the benefits.  It is also possible that the control group ate more fish and therefore had enough serum DHA to skew the results.  This is something that should be addressed when this is studied again.

A third flaw is that this supplement provided 800mg/day of DHA with only 100mg/day of EPA.  Research is mixed on the effect of EPA on depression and brain function.  However, many authors argue that EPA is important in this picture and this study failed to take that into account.  Their goal was to test high dose DHA but we must consider that hardly anything in nutrition works in isolation.  It almost always works in tandem with other nutrients.  This is again an example of a drug based research approach to nutrition.  Drugs are tested in isolation and work in isolation because they are synthetic.  For that reason they cannot work synergistically with the body.  The body has no innate chemical pathway for them to work with because they do not exist in nature.  This allows them to work independent of the body’s systems but also allows them to be tested independently.  Nutrition is not like that.  Not one bit.

One good thing about this study is that DHA was shown to be safe with virtually no side effects.  This is good because women can continue to take fish oil without any fear of negative effects on their babies.

The bottom line is this: fish oil supplementation has been shown repeatedly to be beneficial for many factors in health.  There seems to be little down side to taking fish oil.  This recent study is just one study.  It will unfortunately get a lot of press because it was published in JAMA.  I will continue to encourage my patients to take fish oil during pregnancy because the vast majority of research is positive and I am confident that it is a benefit to my patients.

2 Comments

Filed under Brain Health, Diet, Public Health

Pregnancy, Depression and Drugless Relief

Up to a quarter of all women suffer from depression during pregnancy, and many are reluctant to take antidepressants. Now a new study suggests that acupuncture may provide some relief during pregnancy, even though it has not been found to be an effective treatment against depression in general.

The Stanford University study recruited 150 depressed women who were 12 to 30 weeks pregnant, and randomly assigned 52 to receive acupuncture specifically designed for depressive symptoms, 49 to regular acupuncture and 49 to Swedish massage.

Each woman received 12 sessions of 25 minutes each; those given acupuncture did not know which type they were getting. (In the depression-specific treatment, needles are inserted at body points that are said to correspond to symptoms like anxiety, withdrawal and apathy.)

After eight weeks, almost two-thirds of the women who had depression-specific acupuncture experienced a reduction in at least 50 percent of their symptoms, compared with just under half of the women treated with either massage or regular acupuncture.

There was no significant difference in the rates of complete remission — about a third in each group. The findings appear in the March issue of Obstetrics & Gynecology.

The lead author, Rachel Manber, a professor of psychiatry and behavioral sciences at Stanford, said the results suggested that some symptoms of depression during pregnancy might be related to physical discomfort that is alleviated by acupuncture.

Still, the results were striking, she said, adding, “It’s quite remarkable, especially since the prevalence of depression is highest in the third trimester of pregnancy, so it goes against the course of how you would expect depression to go.”

via Vital Signs – Pregnancy – Some Depression Relief, Without Drugs – NYTimes.com.

Dr. Court’s Comments

Taking any drug is dangerous during pregnancy.  The fact that acupuncture can provide some relief is wonderful news.  Tissues that are most likely to be affected by pharmaceuticals are tissues with high metabolic activity.  Every single tissue in a baby’s body is highly metabolically active because it is growing so fast.  What is particularly scary is that most doctors will say you must weigh the benefits of taking them against the risks, yet antidepressants have shown to be no better than placebo at helping depression! To expose a growing fetus to a drug that has little to no actual value should be criminal.

Below is a list of drugs that are approved for use to treat depression and their potential side effects on growing babies.

Citalopram (Celexa)

Risks: Has been associated with a rare but serious newborn lung problem (persistent pulmonary hypertension of the newborn, or PPHN) when taken during the last half of pregnancy; has been associated with septal heart defects; has been associated with a birth defect that affects the brain and skull (anencephaly), a birth defect that affect sutures on the head (craniosynostosis) and a birth defect that affects the abdominal organs (omphalocele)

Pregnancy Category C (see below for key)

Fluoxetine (Prozac, Sarafem)

Risks: Has been associated with PPHN when taken during the last half of pregnancy

Pregnancy Category C (see below for key)

Paroxetine (Paxil)

Risks: Has been associated with fetal heart defects when taken during the first three months of pregnancy; has been associated with PPHN when taken during the last half of pregnancy; has been associated with anencephaly, craniosynostosis and omphalocele

Pregnancy Category D (see below for key)

Sertraline (Zoloft)

Risks: Has been associated with PPHN when taken during the last half of pregnancy; has been associated with septal heart defects; has been associated with omphalocele

Pregnancy Category C (see below for key)

Amitriptyline

Risks: Suggested risk of limb malformation in early studies, but not confirmed by newer studies

Pregnancy Category C (see below for key)

Nortriptyline (Pamelor)

Risks: Suggested risk of limb malformation in early studies, but not confirmed by newer studies

Pregnancy Category D (see below for key)

Phenelzine (Nardil)

Risks: May cause a severe increase in blood pressure that triggers a stroke

Pregnancy Category C (see below for key)

Tranylcypromine (Parnate)

Risks: May cause a severe increase in blood pressure that triggers a stroke

Pregnancy Category C (see below for key)

Bupropion (Wellbutrin)

Risks: No established risks during pregnancy

Pregnancy Category C (see below for key)

Key:

Category C:

Use with caution if benefits outweigh risks.  Animal studies show risk and human studies not available or neither animal studies nor human studies done.

Category D:

Use in LIFE-THREATENING emergencies when no safer drug available.  Positive evidence of human fetal risk.

The risks associated with these drugs is outrageous considering studies have shown they are ineffective for most people.  You should read category C very carefully.  It says to use with caution is the benefits outweigh the risks.  But the next line says that the studies that were conducted on animals showed that there was risk OR that animal or human studies have not been conducted.  In plain English that means one of the following:

1. The drug was studied in animals and was shown to have some serious risk or…

2. It was never studied in animals or humans.

Do you really want to risk your baby’s health on something that may or may not have been tested and if it was tested (on animals) it was shown to be dangerous?  You must understand that no matter how you look at it, these drugs have never actually been tested on humans while they were pregnant (thankfully!).  This makes them extremely unsafe, particularly when there is a safe alternative out there like acupuncture.

The pharmaceutical industry would love to tell you that their drugs are safe and can be taken by just about anyone.  What they fail to tell you is, in the case of antidepressants, is that they are ineffective wastes of money and the only affect they have is harmful.

If you happen to be pregnant and depressed, which is quite common, I would suggest a trial of acupuncture before you try any sort of medication.  They are no better than placebo therefor making the risks always outweigh the benefits.

Leave a comment

Filed under Big Pharma, Brain Health