Abstract

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 foetus. 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 the current mechanistic understanding of how analgesic compounds cross the placenta and reach the foetus, 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 foetal 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 and 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 the consumption of some OTC analgesics for most stages of pregnancy to be 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.

中文翻译：

---

孕期非处方镇痛药：对全球流行率和后代安全性的全面审查

摘要

背景

孕期镇痛通常是必要的。由于它们的广泛可用性，许多母亲选择使用非处方 (OTC) 镇痛药。这些镇痛化合物及其代谢物可以很容易地穿过胎盘并到达发育中的胎儿。安全性或与不良健康结果相关的证据相互矛盾，限制了医疗保健专业人员的明确决策。

目标和理由

本综述对该领域的研究进行了详细而客观的概述。我们考虑了怀孕期间 OTC 镇痛的全球流行，解释了目前对镇痛化合物如何穿过胎盘并到达胎儿的机制理解，并回顾了当前关于暴露与后代健康结果的关联的研究。

搜索方法

使用 PubMed 和 Scopus 数据库进行了全面的英语语言文献搜索。使用了关键搜索词的不同组合，包括“非处方/非处方镇痛药”、“怀孕”、“自行用药”、“扑热息痛”、“对乙酰氨基酚”、“双氯芬酸”、“阿司匹林”、“布洛芬” '、'宫内暴露'、'胎盘药物转运'、'胎盘转运蛋白'、'胎盘药物代谢'和'后代结果'。

结果

本文从接触证据的不同途径或缺乏证据开始，检查胎儿接触 OTC 镇痛剂的证据，将母体消费与后代健康不佳联系起来。在全球范围内，孕产妇使用非处方镇痛药的流行率非常高，而且还在急剧增加。孕妇选择的镇痛剂选择因人群而异。还观察到位置对使用流行率有影响，较发达国家报告的消费率最高。一些文献侧重于不同妊娠期宫内暴露与神经发育、心血管、呼吸和生殖缺陷的发展之间的关联。这与其他报告没有关联的研究相反。

更广泛的影响

高流行率和报告准确消费率的挑战使孕期非处方镇痛药成为全球紧迫的生殖健康问题。尽管一些医疗保健政策制定机构已经宣布在怀孕的大多数阶段服用一些非处方镇痛药是安全的，但这些决定通常是基于对文献的部分审查。我们对当前证据的全面审查强调，重要的知识差距仍然存在。这些领域需要进一步研究，以便为怀孕母亲在怀孕期间使用非处方镇痛药提供明确的指导。