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A recent study published in JAMA Pediatrics has revealed that exposure to nonsteroidal anti-inflammatory drugs (NSAIDs) during pregnancy is associated with an increased risk of chronic kidney disease (CKD) in childhood. However, this association was not observed in sibling comparisons, which raises questions about other potential contributing factors.
The study, led by You-Lin Tain, M.D., Ph.D., from Kaohsiung Chang Gung Memorial Hospital and the Chang Gung University College of Medicine in Taiwan, analyzed a cohort of 1,025,255 children born in Taiwan between January 1, 2007, and December 31, 2017. The researchers tracked these children for up to 14 years, until December 31, 2021.
Among the 163,516 singleton-born children whose mothers had used NSAIDs during pregnancy, the researchers observed a significant association between gestational NSAID exposure and a 10% increased risk for developing childhood CKD. This was especially true for exposure during the second and third trimesters, with hazard ratios (HR) of 1.19 and 1.12, respectively. However, when sibling comparisons were made, no significant link was found between NSAID use and fetal nephrotoxicity.
Specific NSAIDs were found to be associated with heightened CKD risk during certain pregnancy stages. In the first trimester, indomethacin and ketorolac were linked to increased risks (HRs of 1.69 and 1.28, respectively). In the second trimester, diclofenac and mefenamic acid showed associations with HRs of 1.27 and 1.29. For the third trimester, ibuprofen was the most significant NSAID, with a HR of 1.34.
The study’s findings underline the importance of understanding the potential risks of NSAID use during pregnancy. Despite the observed association between NSAIDs and childhood CKD, the lack of evidence in sibling comparisons suggests the need for further investigation into genetic, environmental, and other factors that could influence kidney development in utero.
The authors of the study have called for additional research to explore how genetic predispositions and environmental factors might contribute to kidney development during different stages of pregnancy, in order to better understand the long-term effects of NSAID exposure.
For more information, see the full study in JAMA Pediatrics (DOI: 10.1001/jamapediatrics.2024.4409).
