ibuprofen doubles risk of miscarriage

Risk of miscarriage more than doubled in women who took non-steroidal anti-inflammatory drugs, or NSAIDs, during the first 20 weeks of gestation, according to researchers who scrutinized health records from nearly 50,000 Canadian women.

The study appears in the latest issue of the Canadian Medical Association Journal.

“I would strongly suggest that women take no non-steroidal anti-inflammatory drugs during the first trimester,” said study co-author Anick Berard, a professor of epidemiology at the University of Montreal and director of the research unit on medications and pregnancy at Centre Hospitalier Universitaire Ste. Justine.”If a woman is taking an NSAID for a chronic condition she really has to talk to her health care provider to see if it’s feasible to stop at least during the first trimester.”

Use of NSAIDs is fairly common, Berard noted, adding that studies have shown that up to 17 percent of pregnant women take the drugs, either in prescription or over-the-counter formulations. The new study investigated use of non-aspirin NSAIDs such as ibuprofen, naproxen and other drugs.

However, a leading expert in maternal fetal medicine cautioned women not to overreact to the new findings. The increased risk could be due to something else that women who took NSAIDS had in common, said Dr. Hyagriv Simhan, associate professor and chief of the division of maternal-fetal medicine at the University of Pittsburgh Medical Center and medical director of obstetrical services at Magee-Womens Hospital of UPMC.

Don’t overreact, expert says “I wouldn’t want this to be a reason for women who have taken a Motrin before they realized they were pregnant to freak out,” Simhan said.

Beyond this, Simhan said, there are legitimate reasons for women to be taking NSAIDS. “This study wouldn’t necessarily make me change the way I practice,” he added.

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.

Berard and her colleagues considered a woman to have been exposed to an NSAID if she had a prescription for the drug filled before she became pregnant or during early pregnancy. Most NSAIDs in Canada are available through prescription rather than over-the-counter, the authors said.

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 all those factors into account, Berard and her colleagues determined that women who took prescription NSAIDs early in pregnancy were 2.4 times as likely to have a miscarriage as those who did not. The rate of miscarriage in women who took NSAIDs was about 35 percent, compared with the normal rate of miscarriage, which is about 15 percent.

While the study didn’t address the kind of over-the-counter use of NSAIDs found in the U.S., the authors cautioned against any use of the drugs in early pregnancy.

“Gestational exposure to any type or dosage of non-aspirin NSAIDs may increase risk of spontaneous abortion. These drugs should be used with caution during pregnancy,” the authors concluded.

NSAIDs may affect prostaglandin levels The researchers hypothesize that NSAIDs could have an impact on pregnancy because the drugs affect the levels of hormone-like substances known as prostaglandins. Normally in pregnancy, prostaglandins decrease in the uterus in a consistent way, Berard said. It’s possible that NSAIDs cause these levels to fluctuate, she suggested.

One thing Berard and her colleagues don’t know was why the women were given prescriptions for NSAIDs. That’s an important factor, Simhan said. It’s always possible that some of the women who miscarried were taking the medications for cramping which is a sign of impending pregnancy loss, he added.

Berard doesn’t believe this is the case. Women who had miscarriages generally didn’t get more prescriptions for NSAIDs in the two weeks leading up to their pregnancy losses, she explained.

Previous studies about the impact of NSAIDs in early pregnancy had shown mixed results, Berard said.

Nevertheless, she does allow that this kind of study can’t prove that NSAIDs actually cause pregnancy loss.

“We cannot say for 100 percent sure that this is a true drug effect,” she said. “But we’re one step closer to proving causality when there is repetition of the finding. And there is at least one other study looking at this specifically that found an increased risk.”

By Linda Carroll

msnbc.com contributor


study shows laid-back parenting can make it matters worse

I spent a half an hour watching Nanny 911 the other day. Wow. What was clear, now being a mom, is that a child’s behavior depends on the parenting. So many times you see the children being the boss of the house, the parents stressed out because of their, “I’ll just do anything to make them stop crying” attitude. I’m guilty of that sometimes! Here is a very recent article on a study that showed that laid-back parenting can actually lead to children who will evolve into anxious, depressed adults.

If Ian McDougall had his way, he’d do his homework on the bus or in the cafeteria — anywhere but at home. That is, if he did it at all.

But Ian, 10, has no choice in the matter. As soon as he gets home from school, mom Jennifer McDougall makes him sit down and complete his homework while she hovers close by.

“If I did not provide very strict parameters for when homework is going to be done and how it’s going to be done, it would never get done,” says McDougall, who happens to teach fifth grade, the same grade Ian will soon enter in Media, Pa.

McDougall is onto something, a new study of moms and children suggests. Although granting kids autonomy is often considered a good thing, for some, it could not only be the wrong approach, but actually increase the child’s anxiety and depression, the authors found.

The study, published this week in the Journal of Abnormal Child Psychology, found that kids who lack self-control feel more anxious if their moms favor a laissez-faire style of parenting. On the other hand, kids who have greater self-control, but whose mothers didn’t allow them much autonomy, tended to be more anxious and depressed.

In fact, children whose moms’ parenting style fit well with their temperament had half as many symptoms of depression as those whose moms’ parenting style wasn’t a good fit, says study co-author Liliana Lengua, a University of Washington psychology professor and mother of three children ages 12, 8 and 4.

“The results show that how much parents need to step in … really does depend on the kid,” says co-author Cara Kiff, who’s working on her Ph.D in psychology at the University of Washington.

For the study, the authors recruited 214 mom-child pairs from elementary schools near their Seattle campus. At the beginning of the study, the kids were in grades three through five. Their average age was 9.

Once a year for three years, trained interviewers visited the moms and kids in their homes to observe the mothers’ parenting styles and to evaluate the children’s personality traits and levels of depression and anxiety over time as measured by standard questionnaires completed by the kids.

In particular, the researchers wanted to see how warm or hostile the moms were and how much they allowed their kids to guide the conversation, which relates to how much autonomy, or independence, they give their kids.

As for the kids, the researchers watched to see how well they could control their own emotions and actions.

Their study has limitations, the authors acknowledge. For one, dads’ participation wasn’t required, and many of the moms were single parents. The researchers collected information about fathers in only 40 percent of the families, too few to compare with the mothers. For another, the scientists didn’t examine whether kids whose temperament appeared to fit well with their mom’s parenting style were more successful in the classroom or on the playground.

How to find the right parenting style? So how can you figure out what parenting style works best for each of your kids? “I think parents feel like they have a good understanding of where their kids are at,” Lengua says. But that doesn’t necessarily mean they’re right, she adds.

You might want to step back and take a hard look at your children, Lengua suggests. “Can they stop themselves from doing things on an impulse? Can they power through things they don’t want to do?” And do they refrain from saying the first thing that comes to mind when they’re upset?

If the answer to these questions is yes, then your child might do better with more hands-off parenting. But if your child falls closer to the other end of the behavioral spectrum, don’t be afraid to wield your authority.

“It’s not that the parent is totally responsible for depression and anxiety,” Lengua says. “The good news for parents is there are things they can do to help reduce those symptoms.”

The earlier you start, though, the better, she says. “Trying to control your kids starting when they’re 14 is much harder than getting a handle on it when they’re 4, 5, 6 or even earlier.”

“The main take-home message,” Lengua says, is that “it’s not one size fits all. The same parenting might not work with each child.”

Not even with each child in the same family, she says. “Siblings can be very different. I always consider myself lucky that I was a temperament researcher before I had kids. All three of them are amazingly different.”

McDougall, who’s married to a school principal, would agree with that. Her younger son, 7-year-old Dylan, is a voracious reader and has always loved school. Unfortunately, though, he started taking after his big brother in the homework department this past year, so he now gets the same after-school treatment.

Says McDougall, “I know that I can’t have a hands-off approach with my kids.”

By Rita Rubin

TODAY.com contributor

educate me

 There is so much to start thinking about. As soon as Audrey came into the world, we were working on her development and education. The older she gets, the more we find ourselves talking about college, homeschooling, tutors, etc…  It is mind boggling. Join in on the conversation and tell me what you think.


Educational programs to “advance” your child start as early as infancy. I’ve spoken before about Your Baby Can Read , a program claiming that your 8-month-old will start reading. Chris and I doubted that, but saw Audrey had a strong liking to the pictures, colors and songs in the videos. The program is now being sued for misleading claims. 

While my husband and I agree that Audrey probably won’t start reading extra early from watching the videos, we don’t find that having her watch a little bit at a time is harmful. She has learned waving, clapping  and singing/dancing from the videos. That isn’t a bad thing. But we do agree that television can be harmful when it is used as distraction. I am guilty of it, but trying my best to just have her watch the short 30 min. film every day or other day.

Another topic at large here in my town is homeschooling. Homeschooling wasn’t too popular when I was growing up in the suburbs, but now with the poor educational system filling way too many children in the classroom and most of the time not living up to teaching our children what needs to be taught, homeschooling is booming. I know a number of children that were or are being homeschooled. They are all very intelligent and mature for their age. But the large responsibility falls on the parent teaching. I don’t know how good I would be at that.

The only thing I argue against homeschooling is that the child is missing the social aspect (which for me, was a fundamental to the shaping of who I am today). Extra curricular activities, friendships, passing notes, watching games, makeups and breakups, the outfits and peer pressure. All those things I find vital to growing up.

Chris and I have talked about charter schools. We both love the idea. Basically a private school without the tuition. That is our favorite choice.

Other topic is tutoring. A number of private tutoring, test preparation and college planning companies have come about since my high school years. I took part in a program which assisted with those things, as well as assistance in getting scholarships. An example would be StudyPoint, which provides in-home, one-on-one tutoring  for grades K-12, as well as test prep, free college information, etc… StudyPoint has been growing immensely with clients and all over the news including being one of Inc.’s 5000 fastest growing companies for the last four years.

I didn’t have the best luck with the program that I did, but they were new then and it seems now parents are doing whatever they can to ensure a good education for their children (again, because they don’t feel like their children are getting the one-on-one education they need).

That is what is in the topic hole for education. So many things to think about. We’re not obsessing about having a genius child (OK, maybe just a little), but we want to provide the best education for her.